Eliminating Barriers to Mental Health Treatment: A Guide for Massachusetts Elders, Families and Caregivers
Massachusetts Association of Older Americans, Inc. Massachusetts Department of Mental Health Massachusetts Executive Office of Elder Affairs Massachusetts Aging & Mental Health Coalition
2nd Edition April 2006
Oh Sweet Spring
Oh sweet Spring in the air the weather is fair. Oh sweet Spring you are my desire, you are a sweet flower. Oh sweet Spring you complete my dreams there is beauty in everything. And now I want to sing Oh sweet Spring.............
Joseph Smith (excerpt of larger poem)
Eliminating Barriers to Mental Health Treatment: A Guide for Massachusetts Elders, Families and Caregivers
According to "Mental Health: A Report of the Surgeon General" (1999), almost one in five persons over 55 experiences some mental disorder. This guidebook was written to provide information about mental illness, treatment options and resources for older men and women. The guidebook is the product of a joint effort of the Massachusetts Association of Older Americans, the Massachusetts Department of Mental Health, the Massachusetts Executive Office of Elder Affairs and the Massachusetts Aging and Mental Health Coalition. Many organizations and individuals provided valuable help and support during the development of the guidebook. The information in this guidebook has been researched and confirmed to ensure accuracy. However, this information may change over time due to the nature of the mental health field and changes in the contact information for community organizations. We welcome comments from readers regarding the information in the guidebook.
Massachusetts Association of Older Americans 105 Chauncy Street, 3rd Floor Boston, MA 02111 617-426-0804
[email protected]
The production of Eliminating Barriers to Mental Health Treatment: A Guide for Massachusetts Elders, Families and Caregivers was supported by a grant from the United States Substance Abuse and Mental Health Services Administration. ©Copyright by Massachusetts Association of Older Americans. For information about duplication or use, please contact MAOA at the above address.
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Table of Contents
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Acknowledgements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .iv Healthy Living . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1 Normal Aging vs. Mental Illness . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3 Myths and Realities of Mental Illness . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .4 Mental Health Disorders and Treatment Options . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5 ■ Depression . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5 ■ Adjustment Disorder . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6 ■ Anxiety Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7 ■ Substance Abuse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .8 ■ Dementia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .9 ■ Delirium . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .9 ■ Psychotic Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .10 Treatments for Mental Health Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .11 Legal Issues . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .13 Insurance and Mental Health Treatment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .16 Challenging Behaviors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .18 Elder Abuse and Neglect . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .19 Diversity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .20 Stigma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .21 References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .22 Resources . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .23
Appendices: Appendix A: Emergency Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .35 Appendix B: Hospitals with Geropsychiatry Units in Massachusetts . . . . . . . . . . . . . . . .45 Appendix C: Aging Services Access Points and Area Agencies on Aging . . . . . . . . . . . .46 Appendix D: Councils on Aging . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .51 Appendix E: Terms and Definitions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .58 Appendix F: Common Abbreviations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .61 Appendix G: Mental Health Websites . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .63
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Acknowledgements
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This guidebook is a product of a joint effort by the Massachusetts Association of Older Americans, the Massachusetts Department of Mental Health, the Massachusetts Executive Office of Elder Affairs, and the Massachusetts Aging & Mental Health Coalition along with the help and support of many organizations and individuals. We would like to thank the following individuals and organizations for their contributions to the development of this guidebook.
Advisory Committee and Contributors: Ted Chelmow, Massachusetts Executive Office of Elder Affairs Lisa Ehle, Graduate Student, Boston University School of Public Health and MAOA Volunteer Carolyn Gibson-Lamaison, Graduate, Manning Certificate Program in Gerontology University of Massachusetts Boston (UMASS-Boston) Chet Jakubiak, Massachusetts Association of Older Americans (MAOA) Joan Kerzner, Massachusetts Department of Mental Health Gwen Lewis, Graduate, Manning Certificate Program in Gerontology UMASS-Boston Michael Ridolfi, Boston Senior Home Care Patricia Rivard, MAOA
Contributors: Frank Baskin, Greater Lowell Elder Mental Health Collaborative Ellen Birchander, UMASS Boston Lester Blumberg, Massachusetts Department of Mental Health James Callahan, Hawthorn Services Holly Erwin, Elder Services of the Merrimack Valley MaryEllen Foti, M.D., Department of Mental Health Joseph Francis, Kit Clark Senior Services Ruth Grabel, Massachusetts Department of Public Health Jennifer Gray, UMASS Boston Ann L. Hartstein, MAOA Massachusetts Behavioral Health Partnership National Alliance for the Mentally Ill-New Hampshire Chapter Alison Theberge, Elder Services of the Merrimack Valley Joel Semuels, Elder Law Attorney Nan Stromberg, Department of Mental Health Ed Wang, Department of Mental Health ELIMINATING BARRIERS TO MENTAL HEALTH TREATMENT
UMASS-Boston Students from Master of Gerontology-Management of Aging Services Program: Organizational Theory, Behavior and Aging Services, and Marketing of Aging Services (2005) A special thanks to the artists and the students who designed the guidebook cover. The front cover was the joint effort of two artists. Lucia, age 83, lives in Newburyport close to her daughter, son-in-law and three grandchildren. Both she and her late husband, Alfredo, were artists who displayed in many art galleries. To inspire their art, they lived abroad in many countries including Italy, Africa, China, Mongolia, Tibet, Australia, New Zealand and South America. Lucia's art medium is oil. She prefers the use of oils because you can layer the paints and "build mountains." The painting shown on the front cover was done by Lucia. Jason Ehle, Cover Sketch Artist is a graphic designer and web site developer for the state of Massachusetts. Jason supports efforts to bring mental health awareness to the Massachusetts community. The poem appearing on the inside front cover was written by Joseph Smith who celebrated his 60th birthday this year. He currently resides in Roxbury, MA. He is active in various community organizations, including Center Club, a vocational rehabilitation program in Boston. He considers himself to be a dedicated artist. He has also been writing poetry for over 30 years. He states that poetry makes him feel better and that he likes to bring out the best in people through his poetry. We would also like to thank those who took the time to read and comment on the information presented in the guidebook.
Massachusetts Association of Older Americans, Inc. Robert Green, President Ann Hartstein, Executive Director Chet Jakubiak, Director of Mental Health Advocacy and Education Patricia Rivard, EBI Project Coordinator
A GUIDE FOR MASSACHUSETTS ELDERS, FAMILIES AND CAREGIVERS
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Healthy Living
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Healthy lifestyles help to maintain physical and mental health. Staying mentally alert and physically active can help prevent disease and maintain emotional wellness. Here are some healthy lifestyle practices and tips.
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Diet and Nutrition ● ●
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Drink 6-8 glasses of water each day Eat a balanced diet that includes vegetables, fruit and whole-wheat products each day Reduce daily intake of sodium Be aware of daily intake of vitamins and minerals Eliminate or moderate use of alcohol Eliminate use of tobacco Be aware of caffeine in coffee, chocolate, tea and soda
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Lack of potassium can result in fatigue, depression and other physical problems. Bananas, orange juice, and spinach are all high in potassium.
Safety, Exercise and Relaxation ●
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Be safe. Have locks on doors, good lighting and no loose rugs or cords Drive safely, reflexes slow with age Exercise to help improve balance, circulation, breathing and overall well-being Dance, join a gym
Engage in activities such as walking, stretching, yoga, Tai Chi, swimming and weight training Use your brain. Solve puzzles, play board games, read, learn to use the internet, develop a new hobby
☞ Councils
on Aging, YMCAs and health clubs offer group and individual exercise and relaxation programs designed especially for older adults.
Socialization Maintain your connections with family and friends ● Consider developing new relationships with neighbors ● Stay connected or reconnect with your church, synagogue or place of worship ● Vary your routine, do something different every day ● Cultivate a sense of humor ● Laugh, smile, tell favorite jokes; laughter is good for the spirit ● Spend time with people of other ages ● Find a way to see children regularly ● Offer your wisdom to those younger than you Many school systems need volunteers to help children with reading and other classroom skills. Check with your local school district or Foster Grandparent Program.
ELIMINATING BARRIERS TO MENTAL HEALTH TREATMENT
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Sexual Health ●
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Relationships between consenting adults can help to decrease loneliness and improve overall well being Always practice safe sex to avoid sexually transmitted diseases
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Health Care ●
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Have a physical examination at least once a year Let your doctor know if you are planning to start an exercise program or change your diet Check your hearing and vision regularly Let your doctor know if you are
having any problems sleeping Keep a list of your health concerns, medications and allergies and bring the list with you whenever you visit the doctor Use alternative medicines safely; remember these are medicines too Bring a friend or family member to an appointment if you will be talking to your doctor about major health concerns or emotional issues
☞ If you don't understand something a
doctor tells you, ask again or ask for a simpler explanation.
A GUIDE FOR MASSACHUSETTS ELDERS, FAMILIES AND CAREGIVERS
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Normal Aging vs. Mental Illness
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Older people are faced with a variety of life crises such as loss of loved ones, loss of independence and the ability to take care of oneself, chronic illness, acute illness and isolation. Sadness and grieving are normal, and support from family and friends is important during these difficult times.
disorder among elders. Ask for help if you, a friend or family member is experiencing any of the following symptoms. ●
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Older adults may experience some short-term memory loss. Forgetting the timing of events and forgetting names is normal. This may be the result of poor nutrition, physical health conditions, a side effect of a medication, or the aging process itself.
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Sometimes additional help is needed when an elder is experiencing depression, anxiety, substance abuse or another mental disorder that impact the ability to function. Late life depression is a commonly experienced mental health
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Sleeping problems - too much or too little sleep Feeling hopeless or unhappy Excessive worrying Lack of interest in everyday activities Confusion or disorientation Difficulty concentrating Feeling nervous or anxious Feeling excessive fatigue Changes in appetite or weight loss Problems managing money Problems managing medications Poor hygiene Unclean or unsafe living environment Thoughts of suicide
Myths and Realities of Mental Illness Myth: Someone with a mental health problem should be able to take care of it him or herself.
Reality: Mild depression or anxiety may be relieved with support and self-help. However, if the problem persists a person should talk with his or her doctor or a mental health professional.
Myth: A person with a mental illness is dangerous.
Reality: A person with a mental illness is no more dangerous than someone suffering from any other disease. In fact, a person with a mental illness is more likely to be a victim.
Myth: A person with a mental illness seems out of touch with reality or exhibits strange behaviors.
Reality: Many people quietly bear the pain of mental illness without showing any outward signs to others or asking for help.
Myth: Depression goes along with old age.
Reality: Older people are faced with a variety of life crises such as loss of loved ones, loss of independence and the ability to take care of oneself, chronic illness, acute illness and isolation. Sadness and grieving are normal and mild depression can occur at any age; but depression is not a normal part of aging and is a treatable condition.
Myth: An elder with a mental illness is not as treatable as a younger person.
Reality: Elders with mental health problems do get better with proper treatment and support. Successful treatment plans include medication, counseling, and exercise programs.
A GUIDE FOR MASSACHUSETTS ELDERS, FAMILIES AND CAREGIVERS
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Mental Health Disorders and Treatment Options
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People with mental health problems do get better with proper treatment and support. The following sections describe mental health disorders and treatment options.
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DEPRESSION
Depression is an intense sadness that interferes with the ability to function. Everyone feels sad once in a while. It is a natural response to loss or disappointment. Depression can occur after a sad event or for no apparent reason. Often depression involves a nagging sense of feeling blue that is overwhelming when trying to perform daily activities. Sometimes it feels like a heavy shroud of despair and emotional emptiness that can be immobilizing. Depression can be life-threatening when the feelings of hopelessness or worthlessness become overwhelming. Without intervention, a person may decide to stop eating or caring for him or herself or consider suicide for relief. When depression occurs in late life, it may be triggered by loneliness, a medical illness or hospitalization. Another common factor is grief following the death of a loved one. Many elders
with chronic illnesses such as heart disease, stroke, cancer or dementia suffer from depression.
What Causes Depression? The cause of depression is unknown but certain chemicals in the brain play an important role. Sometimes an emotional event or an illness may trigger depression. Also, some medications that an individual might take for another illness such as high blood pressure or Parkinson's disease may cause depression.
Types of Depression Late Life Depression is often triggered by medical illness or loss and is a commonly experienced mental health disorder among elders. ● Major Depression lasts at least two weeks and often longer. ● Psychotic Depression is a more severe form of depression and is characterized by a loss of contact with reality and having hallucinations or delusions. ● Seasonal Affective Disorder is associated with a lack of sunlight and usually occurs during the winter months. ● Dysthymic Disorder is a milder form of
ELIMINATING BARRIERS TO MENTAL HEALTH TREATMENT
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depression that lasts for at least two years but may last much longer. ● Bipolar Disorder was once called manicdepressive illness. People may experience intense times of joy and elation and conversely, periods of depression. Older people tend to experience more subtle mania than younger people. They also tend to experience longer periods of depression.
In older adults, the symptoms of depression vary greatly and may include:
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Persistent sadness lasting two or more weeks or feeling empty Difficulty sleeping or concentrating Excessive fatigue Inability to perform daily activities Chronic unexplained physical symptoms, like pain Feeling slowed down Loss of appetite Withdrawing from regular social activities Excessive worries about finances and health problems Pacing and fidgeting Feeling worthless or helpless Weight/appearance changes or frequent tearfulness Thoughts of suicide or death
☞ It is not uncommon to confuse depres-
sion with dementia in an older person.
Treatment Options for Depression ●
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There are different types of antidepressants. Talk with the doctor about choosing a drug with minimal side effects and minimal interactions with other medications. Counseling is very effective with older people. Often individual or group counseling offers an opportunity to identify the cause of the depression and help the older person develop coping mechanisms and tools to reduce the symptoms and function more positively. ● Exercise Programs are recommended to relieve stress, increase energy and improve physical and mental well-being. ● Light Therapy may be recommended for people who have seasonal depression. ● Electro-convulsive Therapy (ECT) may be recommended when other treatments are not successful or when there are complex medical problems that make ECT a safer and better choice. ● Combinations of treatments, including drug therapy, counseling and an exercise plan, often are an effective package for older people who are able to participate in this combination. ●
Symptoms of Depression:
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effective in older people with depression. However, it may be necessary to try more than one anti-depressant to find the best one.
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ADJUSTMENT DISORDER
Adjustment disorder is the development of emotional or behavioral symptoms in response to an identifiable stressor, i.e., anything that causes a great deal of stress in the person's life, such as physical illness, disability, loss of loved ones, leaving a family home or entering a nursing home.
Medications (called anti-depressants) are A GUIDE FOR MASSACHUSETTS ELDERS, FAMILIES AND CAREGIVERS
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Symptoms of Adjustment Disorder may include: ● ● ●
Lack of appetite, refusing to eat Withdrawing from social interactions Significantly decreased ability to carry out personal care tasks
Obsessive-Compulsive Disorder (OCD) is characterized by repetitive behaviors and/or recurrent thoughts such as continuous checking, cleaning or hand washing. OCD disorders also include hoarding and eating disorders.
Symptoms of OCD may include: ●
Treatment Options for Adjustment Disorders: 7
Psychotherapy is the treatment of choice for any adjustment disorder, since the disorder is usually a normal reaction to a specific situational event. The form and type of psychotherapy will vary depending upon the clinician and should occur within a supportive, nonjudgmental environment. Medications typically are not recommended in the treatment of adjustment disorders.
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ANXIETY DISORDERS
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Panic Disorder is characaterized by unexpected and repeated episodes of intense fear accompanied by physical symptoms that may include chest pain, heart palpitations, shortness of breath, dizziness or abdominal distress.
Symptoms of Panic Disorder may include: ●
Like late life depression, chronic illness, cognitive impairment and emotional losses make older adults especially vulnerable to anxiety disorders. If anxiety becomes excessive and irrational, it can become disabling.
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Types of Anxiety Disorders Generalized Anxiety Disorder (GAD) is characterized by chronic anxiety, exaggerated worry and tension when there is nothing to provoke it.
Symptoms of GAD may include: ● ● ● ● ●
Fatigue and headaches Muscle tension and muscle aches Trembling and twitching Irritability Excessive sweating
Urgent need to engage in certain rituals An obsession with germs or dirt Frequent washing of hands Hoarding Feelings of doubt and need to check things repeatedly
Feelings of terror that strike suddenly and repeatedly with no warning Tingling or numbness in hands Flushing or chills Nausea, chest pain or smothering sensations Sense of unreality, or fear of impending doom or loss of control
Post-Traumatic Stress Disorder (PTSD) can develop immediately or at a later time after exposure to a terrifying event or ordeal in which grave physical harm occurred or was threatened. Traumatic events that may trigger PTSD include violent physical or sexual assaults, natural or human-caused disasters, accidents, or military combat.
ELIMINATING BARRIERS TO MENTAL HEALTH TREATMENT
Symptoms of PTSD may include: Persistent frightening thoughts and memories of the ordeal ● Sleep problems ● Feeling detached or numb ● Becoming easily startled and frightened
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SUBSTANCE ABUSE
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Phobic Disorder is characterized by an irrational fear that produces a conscious avoidance of the feared subject, activity or situation. The affected person usually recognizes that the reaction is excessive but can't necessarily control the reaction. Fear may be so severe as to interfere with ordinary activities.
Types of Phobic Disorders: Specific phobias: fear of a specific activity or thing Social phobia: fear of being in a place with other people, fear of being watched and judged by others and being embarrassed or humiliated Agoraphobia: fear of open places
Treatment Options for Anxiety Disorders Medication and specific types of counseling or therapy can be very effective for older people with anxiety disorders. Before treatment begins, the doctor will determine whether the symptoms are due to an anxiety disorder and the type of anxiety disorder. Anxiety disorders are not all treated the same way and it is important to determine the specific problem before starting treatment. Sometimes alcoholism or some other conditions will have such an impact that it is necessary to treat it at the same time or before treating the anxiety disorder.
Substance abuse includes excessive drinking, and/or misuse of prescription medication, over-the-counter medication or illegal drugs. Drugs or alcohol may produce interactions with illnesses and other medications. Substance abuse can lead to amnesia, delirium, convulsions, ulcers, confusion, anemia, liver and heart complications, falls and accidents, social isolation and inability to manage tasks of daily living.
☞ Older people may self medicate or not
take medications as prescribed.
Symptoms of Substance Abuse may include: ● ●
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Sneaking drinks and gulping first drinks Unwillingness to discuss or lying about drinking Memory blanks and impaired thinking Flashes of aggression Loss of friends Unreasonable resentments and noticeable self-pity Regular morning drinking Tremors
Treatment Options for Substance Abuse Treatment includes structured programs such as Alcoholics Anonymous (AA) or Narcotics Anonymous (NA), counseling with family supports, and medications for withdrawal in severe cases. Treatment may be provided in a hospital or in an outpatient setting.
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It is important to involve family in a treatment plan. A GUIDE FOR MASSACHUSETTS ELDERS, FAMILIES AND CAREGIVERS
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DEMENTIA
Dementia is not a specific disease. It is a term used to describe a collection of symptoms that affect the brain. Alzheimer's Disease is the most common cause of dementia. People with dementia have impaired intellectual functioning that interferes with normal activities and relationships. Many diseases and conditions can cause symptoms of dementia. Research suggests that brain cells may reproduce throughout the life span.
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Dementia is not a normal part of the aging process.
Symptoms of Dementia include: Inability to solve problems ● Inability to maintain emotional control ● Personality changes ● Agitation ● Delusions or hallucinations ● Memory loss Memory loss is a common symptom of dementia but memory loss does not necessarily mean that a person has dementia. ●
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Delirium is a term that refers to treatable and reversible memory problems. Delirium looks like dementia, but its onset is sudden (i.e., develops within hours or days) while dementia has a gradual progression. There are many things that cause delirium, including a number of medical conditions (e.g., urinary tract infections), medication side effects, and drug and alcohol intoxication and withdrawal. A potentially life-threatening illness, delirium is preventable and treatable.
Symptoms of Delirium may include: ●
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Treatment Options for Dementia Medications to treat Alzheimer's disease are now available. Although these drugs do not halt the disease or reverse existing brain damage, they can improve symptoms and slow disease progression. Many researchers also are examining whether these drugs may be useful for treating other forms of dementia.
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Inability to respond normally to people or events in the environment Reduced ability to focus or shift attention, difficulty paying attention when addressed Impaired memory Disoriented to time (e.g., thinking it is morning in the middle of the night) and place Symptoms that change over the course of the day Increased anxiety, suspicion and agitation Hallucinations (e.g., seeing people who are not really there)
Treatment Options for Delirium ●
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Keeping your brain active by doing regular exercise, eating well, learning a new hobby, or engaging in such activities as playing cards or games, and dancing, may delay or prevent the onset of dementia
DELIRIUM
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Requires a comprehensive medical examination to identify life-threatening causes of the delirium; Requires acute intervention, usually hospitalization; Medications are available for delirium related to specific causes.
☞A sudden change in memory or physical
functioning is a "red flag" to indicate that
ELIMINATING BARRIERS TO MENTAL HEALTH TREATMENT
delirium may be present. It is imperative to see a physician whenever such change is noticed. Delirium can be treated, but if not treated correctly or in a timely way it may decline into a non-treatable condition.
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PSYCHOTIC DISORDERS
Psychotic disorders may affect as many as one in 50 older people. The major characteristics of psychosis are loss of contact with reality, delusions and hallucinations. ● Delusions are false beliefs, such as believing that people are trying to hurt you when there is no evidence of this or believing that you are somebody else. ● Hallucinations are false perceptions, such as seeing or hearing things that are not there. Schizophrenia This is a serious brain disorder that affects how a person thinks, feels and acts. Generally, the illness affects a person's ability to distinguish between real and unreal experiences that may be the result of disorganized thinking, delusions or hallucinations. This type of psychotic disorder typically appears during late adolescence or young adulthood and can last throughout one's life. Schizophrenia may require long-term treatment and intervention.
Late onset schizophrenia. People with 'latelife' schizophrenia develop symptoms of the disease (delusions and hallucinations) after age 45. Typically, this illness is milder than the form that appears in late teens or early 20's, and it is more responsive to treatment. Individuals in this older group have usually been married and employed. Family studies indicate that lateonset schizophrenia is less inheritable than early-onset schizophrenia. Psychosis May result from a severe illness or infection. Usually this is temporary. Brain injury from a stroke or tumor also may cause psychosis. An older person who is hospitalized and sleepdeprived may develop psychotic symptoms. Excessive alcohol abuse and some drugs may cause temporary psychosis.
Treatment Options for Psychotic Disorders ●
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Medication can reduce or eliminate psychotic symptoms. Reinforcement from family, friends and other support systems often helps the person feel safer and more secure. Services may be needed to assist with daily living skills, financial matters, and housing. Therapy can help a person learn better coping skills.
A GUIDE FOR MASSACHUSETTS ELDERS, FAMILIES AND CAREGIVERS
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Treatments for Mental Health Disorders
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Who decides what mental health services are provided? The affected individual and the doctor or therapist will determine the service plan to treat a mental health disorder. The insurance company will decide what services are covered. Counseling is very effective with older people. Often, individual or group counseling offers an opportunity to identify the cause of the illness, and help to develop coping mechanisms and tools to reduce the symptoms and produce more positive functioning. Medication is one of the many treatment options for elders with mental health disorders. Exercise, diet, regular medical care and appropriate counseling are other important parts of an overall plan to stay as healthy as possible.
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Different doctors may prescribe multiple medications. It is important to inform the psychiatrist and the primary care physician of all medications that have been prescribed. The Department of Mental Health (DMH) publishes a Medication Information Manual
that describes the most commonly prescribed medications to treat mental illness, including the purpose and possible side effects of each medicine. The Manual is available on the DMH website at: www.mass.gov/dmh or by contacting DMH at 1-800-221-0053.
☞ It is important to take prescribed med-
ication as directed. Alcohol and other medications may interact with the new medication. Hospitalization: Some elders may need treatment in a psychiatric hospital setting. Some psychiatric units are free-standing hospitals, others are units within general hospitals. Some hospitals have special inpatient units for older adults called geropsychiatric units. (See Appendix B for listing.) Voluntary and Conditional Voluntary Admission: Individuals who are competent to understand that they are seeking admission to a psychiatric facility for treatment, and that they may leave the hospital upon request, may be admitted to a psychiatric hospital on a voluntary or conditional voluntary basis. A hospital must discharge a voluntary patient who requests to be discharged. If a patient on a conditional voluntary status asks to be discharged, the
ELIMINATING BARRIERS TO MENTAL HEALTH TREATMENT
facility can retain the person for up to three business days to determine whether the person can be safely discharged, or whether to petition for the person's commitment (see below). Most psychiatric facilities only accept conditional voluntary admissions, and not voluntary admissions. Involuntary Admission: If a clinician (a physician, psychologist or a specially licensed mental health clinical nurse specialist), or in some cases a police officer, believes that without hospitalization, a person would create a likelihood of serious harm to him or herself or to others, by reason of mental illness, he or she may authorize the person to be involuntarily transported to a hospital for psychiatric evaluation. (This is commonly referred to as a "Pink Paper," or a "Section 12" process.) If the evaluating physician also believes that there is a likelihood of serious harm to the person or to others, the person may be involuntarily admitted to a psychiatric hospital for further evaluation for up to three business days. Any person may apply to the District Court for a three-day commitment of an individual thought to be mentally ill if the person believes that failure to hospitalize the individual would result in a serious likelihood of harm to the individual or others. If the Court agrees that there is such a risk, then the individual will be brought to the Court (by the police, if necessary) for an examination by a physician or psychologist. After the examination and hearing, a judge may order that the individual be committed to a psychiatric hospital for further evaluation for up to three business days.
three-day evaluation has the right to apply for voluntary or conditional voluntary status upon admission. The psychiatric hospital can discharge the person before the three day period is up, if it is determined that it is safe to do so. However, if the clinicians at the hospital believe that the person is suffering from a mental illness, and that without further hospitalization, there is a likelihood of serious harm to the person or to others, and the person does not agree to stay on a conditional voluntary basis, the hospital may file a petition in the District Court to have the person involuntarily committed to the hospital. The petition must be filed within three business days of the person's admission. The District Court will hold a hearing within five business days, and the clinicians will have to prove beyond a reasonable doubt that the person has a mental illness, that there is a likelihood of serious harm, and that there are no less restrictive alternatives to hospitalization.
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If you have questions about your rights in connection with psychiatric hospitalization, contact an attorney that specializes in mental health issues, or contact the Mental Health Legal Advisors Committee at 617-338-2345 or 800-342-9092
A person who is involuntarily admitted for a A GUIDE FOR MASSACHUSETTS ELDERS, FAMILIES AND CAREGIVERS
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Legal Issues
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Our laws presume that adults are competent to make important life decisions, including medical and financial decisions. Friends, physicians and family members may give advice but individuals make the final decision. This section explains rights that older adults with mental health and medical issues have and some of the legal issues they may face. Detailed explanations are available from attorneys and organizations with expertise in mental health law and elder law. Durable Power of Attorney: A durable power of attorney is a legal document signed by a competent person that appoints another person (called an agent) to handle financial affairs during periods of sudden incapacity or incompetence. A general power of attorney becomes effective when the document is executed and gives the agent immediate power to act if necessary. ●
A springing power of attorney is drafted but "springs" into action only when the person becomes incapacitated. ●
Advance Directive: An advance directive is a document written by a person before an illness or injury occurs to state preferences about medical care and treatment in the event of an illness or injury. This enables a person to choose a decision-maker before becoming ill and to
define and communicate values and wishes regarding care and treatment if he or she is unable to make health care decisions.
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In Massachusetts an advance directive is documented through a Health Care Proxy Health Care Proxy: A health care proxy allows a competent adult aged 18 or over (called principal) to appoint a family member or friend (called health care agent) to make health care decisions if the principal loses the capacity to make or communicate these decisions. It can also specify what treatment a person wants or does not want. If mental illness or developmental disability is the cause of the incapacity, a physician with specialized mental health training or experience or in consultation with a health care professional with such training or experience must attest to the incapacity.
How does a Health Care Proxy Work? The health care proxy must be signed in front of two adult witnesses. ● The principal must be of sound mind and not under any constraint or undue influences. ● The health care proxy is put into effect only when the treating physician determines that the principal is not able to make or communicate health care decisions and seeks permission to treat from the agent.
ELIMINATING BARRIERS TO MENTAL HEALTH TREATMENT
●
A principal may revoke a health care proxy at any time and/or may choose a new health care agent. ●
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Copies of the Health Care Proxy should be given to the health care agent, family member, an alternate agent, physician and health care providers.
Making Your Wishes Known You should talk with your health care agent about: ● Your attitude toward life, what you love and what you fear ● Any religious and spiritual beliefs that may influence your feelings about serious illness ● Your thoughts and feelings about physical illness, psychiatric illness, dying and death ● Concerns you may have about the care you will get if you cannot make decisions for yourself ● How you want to be treated if you are terminally ill, in a coma or very psychiatrically ill ● What treatments you want to receive or refuse Living Will: A living will is a document that provides instructions about a person's wishes to receive or refuse treatment if he or she is unable to communicate because of a terminal illness or condition. ● A living will is often done in the same way as a regular will with two witnesses and a notary public. The terms of a living will may be changed or revoked at any time while a person is mentally competent to do so.
☞ Keep the original Living Will in a secure
place accessible by others and give copies to doctors, hospitals and family members.
Difference between Health Care Proxy and Living Will A health care proxy appoints an agent to make any health care decisions for the principal, while a living will addresses terminal illnesses only. ● A living will is not recognized as a legal document in Massachusetts. A health care proxy is recognized as a legal document. However, a living will may be used in Massachusetts as evidence of an individual's wishes regarding medical treatment. ●
Court Appointed Decision Makers Guardian. A guardian is a person appointed by the Court to make personal, financial and medical decisions on behalf of a person who is unable to manage his or her own affairs. Guardians may be appointed for adults who are unable to care for themselves by reason of mental illness or mental retardation, and for those who become unable to make or communicate informed decisions because of illness or injury. Guardian's Authority to Admit. A guardian must follow a special Court process to admit a person to a mental health or mental retardation facility. This includes private or state hospitals for people with mental illness, and locked psychiatric units. It does not apply to halfway houses, general hospitals and nursing homes. The Court must hold a hearing. The person must be represented by counsel and has a right to be present. If the person agrees, the guardian must show that an admission for treatment is in the person's "best interest." If not, the guardian must prove the need for hospitalization "beyond
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a reasonable doubt" and must demonstrate that a failure to hospitalize the person would create a likelihood of serious harm by reason of mental illness and that retention is the least restrictive alternative.
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Conservator. A conservator may be appointed by the Court for a person unable to properly care for his/her property because of mental or physical incapacity. A conservator is responsible for the care and management of the person's property such as handling the finances and paying the bills. A conservator may be appointed after a friend,
family member or human services agency files a petition with the Court. Representative Payee. A representative payee is an individual or organization authorized by the Social Security Administration to cash and manage Social Security, Supplemental Security Income (SSI) and Social Security Disability Income (SSDI) checks. A payee acts on behalf of the beneficiary who is either mentally or physically unable to do so. Benefit checks are sent to payees who then endorse and deposit them in a separate bank account for the beneficiary.
ELIMINATING BARRIERS TO MENTAL HEALTH TREATMENT
Insurance & Mental Health Treatment Health insurance generally provides coverage for mental health services. This includes Medicare, MassHealth/Medicaid, and private health insurance plans. Before treatment, check with your doctor or mental health professional to make sure they accept your insurance plan. Medicare is the federal health insurance plan offering hospital and medical coverage for people 65 or over, and for certain other chronically disabled persons who qualify for benefits. Medicare covers mental health treatment by a physician or other mental health professional such as a psychologist, social worker or nurse practitioner. Since many mental health services are not covered by Medicare, it is important to ask your provider if a specific service is covered. Hospital Care: Medicare Part A covers inpatient mental health care services in a general hospital or in a psychiatric hospital that only cares for people with mental health needs. There is a 190-day lifetime limit on care in a psychiatric hospital. Outpatient Care: Medicare Part B covers mental health services provided in an office setting or hospital outpatient department by a physician, clinical psychologist, clinical social worker, clinical nurse specialist or physician assistant. Coverage is subject to the annual Part B deductible and you may be expected to pay approximately 50% of the Medicare approved amount for the covered service.
☞ Make sure the health insurance plan you
have covers the medications in the dosages you need! Prescription Drugs: On January 1, 2006, Medicare began offering prescription drug benefits through private health insurance plans. This coverage is known as Medicare Part D coverage. If you are a MassHealth/Medicaid beneficiary, you must select a Medicare Part D plan. Others may select from Medicare Part D plans that are offered in their areas. Because so many plans exist and plans may be very different from each other in the mental health medication benefits they offer, it is important to choose a plan carefully. Before enrolling in a plan you should: ● Know what antidepressant and antipsychotic medications are covered by the drug plans available to you and if they cover the medications you are currently taking; ● Know if the dosage you need of your current medication is covered; ● Know if the plan will require you to try a different medication than the one you are taking before authorizing coverage for your current medication; ● Know what the co-payment is for each prescription; ● Know if the pharmacy you use is in the plan. For information about Medicare, contact: ● Medicare Program - 1-800-Medicare
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(1-800-633-4227), www.medicare.gov ● Medicare Advocacy Project 1-800-3233205 ● SHINE1-800-AGE-INFO (1-800-243-4636), www.medicareoutreach.org SHINE provides free, one-on-one health insurance information, counseling and assistance to Medicare beneficiaries of all ages.
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Medicaid/MassHealth provides health care insurance to low-income elders. Eligibility is based on income and assets. Covered services include: outpatient mental health and substance abuse treatment, emergency services and inpatient services. MassHealth Customer Service 1-800-8412900
The Massachusetts Mental Health Parity Law requires some insurers who offer mental health benefits to cover the diagnosis and treatment of certain mental disorders to the same extent that they cover the diagnosis and treatment of other physical disorders. The law also provides for minimum outpatient and inpatient benefits for those disorders not required to be treated the same as physical ailments. For more information about Medicare Part D and mental health medication coverage, the Massachusetts mental health parity law and other mental health services insurance coverage questions contact: Mental Health Legal Advisors Committee 1-800-342-9092 or 617-338-2345
ELIMINATING BARRIERS TO MENTAL HEALTH TREATMENT
Challenging Behaviors
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Changes that a loved one, friend, or neighbor may encounter as they age can be difficult. Remember that older adults continue to have new experiences and have a wealth of past experiences. It can be a challenge to provide support to an elder who is experiencing a mental health problem or dementia. Here are some of the behaviors and problems that elders experiencing mental illness or dementia may exhibit: ● impatience ● anger or agitation ● yelling or cursing ● banging objects or slamming doors ● losing keys or wallet ● forgetting appointments or medications ● failing to eat ● home appears disorganized ● hoarding/accumulating "stuff" ● deteriorating hair, skin or dental hygiene ● dirty or unmatched clothing ● pacing or wandering
rooms with signs or simple pictures, such as a picture of a toilet outside the bathroom or a picture of the person outside her room. Store sharp objects, such as glasses, razor blades or knives safely. ● ANGER MANAGEMENT. Anger may be a symptom of an illness or a change in condition. Learn warning signs. Use interventions that have been successful. Keep the environment calm, respond in a calm, uncomplicated way, and take short walks. ● PROFESSIONAL HELP. Contact a nurse, social worker, physician, mental health professional (or local mental health agency for a referral) to conduct a professional assessment if needed.
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Support for the Caregiver. Take care of yourself. Visit friends, take walks, exercise, become educated about your friend or loved one's illness and ask for help.
What Can You Do? STAY CALM. Be patient, take it slow, speak calmly, step back, breathe deeply, count to ten. ● SIMPLIFY. Communicate in simple terms. Look at old photo albums together, make sandwiches, fold laundry, take short walks. ● PLAN. Daily routines provide needed structure. Ask visitors to call first. ● MODIFY THE ENVIRONMENT. Make simple changes, such as installing gates between rooms and room monitors. Label objects and ●
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Elder Abuse and Neglect
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Mistreatment of an elder may take the form of physical abuse, emotional abuse or neglect. It may be caused by individuals who have a close relationship with the elder, including spouses, partners, adult children, siblings, household members or caregivers, and may be an intentional act to inflict suffering or unintentional because of inadequate knowledge or stress on the part of the caregiver or abuser. Elders with a mental or physical disability who depend on others for care may be more vulnerable to becoming victims.
Elder abuse can be grouped under four main areas: Physical. the non-accidental infliction of serious physical pain or injury, including sexual molestation, pushing, pulling hair, hitting or battering Psychological. the non-accidental infliction of serious mental anguish, including humiliation and intimidation and verbal abuse Neglect. the failure or refusal to provide daily necessities such as food, clothing, shelter, personal care or medical care which will result in serious physical harm Financial. the improper exploitation or use of an elder's funds and or assets, including pressure to turn over personal property
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Is physically restrained
Protective Services: It is against the law to abuse, neglect, or exploit elders. If you know someone that is being mistreated by a family member, friend, neighbor or caregiver, PLEASE REPORT the situation to the Massachusetts Executive Office of Elder Affairs Elder Abuse Hotline or a local Aging Service Access Point's protective service unit. Note that certain professionals are required to report known abuse. Professionals are available 24-hours, 7days a week to investigate and intervene in situations where there is evidence of elder abuse, neglect or financial exploitation in domestic settings.
Please seek help if an elder: ● Is fearful of a family member or caregiver ● Has unexplained injuries, broken bones or burns ● Appears neglected, abused, or mistreated ELIMINATING BARRIERS TO MENTAL HEALTH TREATMENT
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Elder Abuse Hotline 1-800-922-2275
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Diversity
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Different cultures have different beliefs around aging. Many cultures treat elders with care and respect. However, mental health problems may be dealt with differently, depending on a person's cultural background. Diversity may be defined in terms of the many different people that make up our society.
practices related to mental problems.
Elders may experience isolation and barriers to services because of advanced age, cultural beliefs, language barriers, access to care, lack of insurance coverage, mental illness or other health problems. Differences also include: ● Gender ● Marital Status ● Religion ● Culture ● National Origin ● Ancestry ● Language ● Sexual Preference ● Race ● Career ● Skills ● Interests ● Physical Appearance ● Health ● Income ● Education ● Mental Health
Massachusetts has many resources for individuals of diverse backgrounds. The Department of Mental Health's Office of Multicultural Affairs publishes a detailed list of organizations that provide culturally sensitive and appropriate services for elders in Massachusetts. This list is available on the DMH website at www.mass.gov/dmh or by contacting the DMH Office of Multicultural Affairs at 617-626-8134.
Cultural competence is a goal of healthcare practitioners to provide effective care for a diverse population. It acknowledges differences in beliefs, values and help-seeking behavior to effectively diagnose and treat individuals.
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"A BOOK CANNOT BE JUDGED BY ITS COVER"
Cultural beliefs may affect a person's willingness to seek and respond to mental health services because of their understanding and A GUIDE FOR MASSACHUSETTS ELDERS, FAMILIES AND CAREGIVERS
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Stigma
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Stigma, defined as discrimination or a mark of shame, is a harmful process that affects people of all ages, including elders. Judging individuals or groups of people through the use of labels or names may cause them to feel less worthy compared to others in society. Do we "stigmatize" people without knowing we are doing it? Discriminating against a person because of their age is an example of stigma. Failing to seek help because stress or mental illness is seen as personal weakness or something shameful is another example. In line at the grocery store an older person in front of you carefully counts out exact change to pay the bill instead of using an ATM card or credit card. You notice the clerk rolling her eyes. ● Do you find yourself feeling impatient? ● Are you angry that this old person is slowing you down? ● Do you think all older people are like this? At the park each weekend, there is always a well-dressed woman sitting alone on the same bench. She never smiles or says hello. You attempt to say hello but she raises her hand in a gesture that seems to say "don't speak or come closer." ● Do you think she is a just an "unfriendly old lady?" ● Do you feel frustrated or annoyed that she will not respond to you? At the clinic you have limited time and a
long list of patients for the day. An 80-year-old man comes in and seems to be in a "bad mood." He talks a great deal about the television shows he watches, the snacks he eats, and the job he held for 40 years. You notice that he becomes angrier as he talks. He begins to shift and talk about buses being late, things not being the way they "used to be." He complains of vague aches and pains but cannot be terribly specific. ● Do you feel impatient and start looking at your watch? ● Do you decide he is psychosomatic and order some tests to make him feel you are doing something? ● Do you think this is the way all old people are?
Are we viewing things through our own lens? In the grocery store: Perhaps the woman in front of you recently had cataract surgery and is experiencing some vision problems. Perhaps she has arthritis that affects her hands. Maybe she has extremely limited funds. ● In the park: Is the woman in the park from another country? Could her facial features mean something else? Maybe she is depressed or has recently lost a spouse or loved one. ● In the clinic: Has the man in your office recently lost a family member or close friend? What has changed since his last visit? Are his vague symptoms a mask for depression? ●
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Stigma is harmful and may prevent elders from getting help because of the inaccurate perceptions of others.
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References Mental Health, Mental Illness, Health Aging: A NH Guide for Older Adults and Caregivers, January 2003 Edition National Alliance for the Mentally Ill, New Hampshire, Concord, NH. 21
Ronald J. Comer. (1999) Fundamentals of Abnormal Psychology, Second Edition, Worth Publishers, Inc. American Psychiatric Association. (1994). Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. Washington, DC.
American Psychiatric Association. Merck Manual of Health and Aging, (2004) West Point, PA: Merck and Co. Schaie, K., Willis, S., (2002) Adult Development and Aging, Fifth Edition, Prentice Hall.
Websites: www.familydoctor.org www.nih.gov
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Resources for Massachusetts Elders The following is a list of key contacts and an overview of some of the resources available to elders and their families in Massachusetts. Some of these resources have financial eligibility criteria, some are available to elders with specific needs and others are available to all elders Telephone numbers are listed under each category. 23
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Key Contacts: 1-800-221-0053 www.mass.gov/dmh
1-800-AGE-INFO (1-800-243-4636) www.mass.gov
Department of Mental Health provides services and information to individuals with mental illness.
See Appendix A for a list of mental health agencies that provide crisis/emergency services to all individuals regardless of age or insurance coverage. ----------------------------------------------------------------------------------------Executive Office of Elder Affairs provides services and information to assist Aging Services Access Points/Area Agencies on Aging and Councils on Aging covering every city and town in Massachusetts
See Appendix D for a list of Councils on Aging and telephone numbers. -----------------------------------------------------------------------------------------------------------------------------
Financial Resources:
Federal and state programs are available for eligible elders including retirement benefits, disability benefits, Supplemental Security Income and Veteran's Pensions. Social Security Administration 1-800-772-1213 U.S. Department of Veteran's Affairs 1-800-827-1000 Massachusetts Department of Veterans Services 617-210-5480 -----------------------------------------------------------------------------------------------------------------------------
Health Insurance:
Medicare is the federal health insurance program offering hospital, medical and prescription drug coverage for people 65 or over who qualify. CMS - 1-800-633-4227 ELIMINATING BARRIERS TO MENTAL HEALTH TREATMENT
Medicare Advocacy Project 1-800-323-3205 Serving Health Information Needs of Elders provides health insurance information, counseling and assistance for Medicare beneficiaries. 1-800-AGE-INFO (1-800-243-4636) MassHealth provides health care insurance to low-income elders. Eligibility is based on income and assets. Elders who do not meet eligibility for MassHealth may be eligible for assistance with Medicare premiums and co-payments (called QMB or SLMB). MassHealth Customer Service 1-800-841-2900 -----------------------------------------------------------------------------------------------------------------------------
Legal:
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Assistance to individuals who need help accessing mental health services and legal representation of people involved in the mental health system Mental Health Legal Advisors Committee 1-800-342-9092 -----------------------------------------------------------------------------------------------------------------------------
Home Care and Caregiver Support:
Support services such as personal care, transportation, and day care are provided to elders in need of services to be able to remain in the community. Respite services are provided to caregivers supporting elders in a community setting Elder Information Line 1-800-AGE-INFO (1-800-243-4636) -----------------------------------------------------------------------------------------------------------------------------
Housing Resources:
There are many housing options for elders including subsidized elderly housing, congregate housing, supportive living, rest homes, assisted living facilities and family care. Elder Information Line 1-800-AGE-INFO (1-800-243-4636) or Contact City/Town Housing Authority -----------------------------------------------------------------------------------------------------------------------------
Property Tax Discounts and Fuel Assistance:
Homeowners may qualify for tax relief. Financial assistance is available to help with home heating fuel. Contact Council on Aging or City/Town Hall or Elder Information Line 1-800-AGE-INFO (1-800-243-4636) -----------------------------------------------------------------------------------------------------------------------------
Nutrition:
The Elderly Nutrition Program provides meals at Senior Centers and nutrition sites across Massachusetts. Home delivered meals are provided to elders who are unable get to the meal site. Elder Information Line 1-800-AGE-INFO (1-800-243-4636) Contact Council on Aging A GUIDE FOR MASSACHUSETTS ELDERS, FAMILIES AND CAREGIVERS
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Mental Health Services:
Mental health services for elders in Massachusetts may be provided in a hospital, clinic, private office, group setting or in an individual's home. Department of Mental Health 1-800-221-0053 Elder Information Line 1-800-AGE-INFO (1-800-243-4636) Patient Protection Line 1-800-436-7757 -----------------------------------------------------------------------------------------------------------------------------
Substance Abuse:
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Help is available to elders in Massachusetts to prevent, treat and recover from the effects of alcohol or drug abuse. Referral specialists are available 24 hours a day, seven days a week to help find the appropriate service. Substance Abuse Help-Line 1-800-327-5050 -----------------------------------------------------------------------------------------------------------------------------
Ombudsman:
An Ombudsman is available to help elders by resolve complaints regarding services provided in nursing facilities, assisted living facilities and community programs. Elder Information Line 1-800-AGE-INFO (1-800-243-4636) Patient Protection Line 1-800-436-7757 -----------------------------------------------------------------------------------------------------------------------------
Protective Services:
Professionals are available 24 hours a day, 7 days a week to investigate and intervene in situations where there is evidence of elder abuse, neglect or financial exploitation. Elder Abuse Hotline 1-800-922-2275 -----------------------------------------------------------------------------------------------------------------------------
Diversity:
The Department of Mental Health's Office of Multicultural Affairs publishes a detailed list of organizations that provide culturally sensitive and appropriate services to elders in Massachusetts. DMH Office of Multicultural Affairs
617-626-8134
State Agencies and Elder Service Organizations Department of Mental Health (DMH) www.mass.gov/dmh
1-800-221-0053 617-727-9842-TTY
DMH sets standards for the operation of mental health facilities and community programs, and provides services and information to individuals with mental illness. DMH also funds contracts with area mental health agencies to provide 24-hour crisis/emergency services to all individuals, regardless of age or insurance coverage. (See Appendix A for list of mental health agencies that provide crisis/emergency services.) ELIMINATING BARRIERS TO MENTAL HEALTH TREATMENT
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DMH Area Offices: Metro Boston Area Northeast Area (Tewksbury) Southeastern Area (Brockton) Central Massachusetts Area (Worcester) Western Massachusetts Area (Northampton) Metro Suburban Area (Westborough) DMH Central Office (Boston)
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617-626-9200 978-863-5000 508-897-2000 508-368-3838 413-587-6200 508-616-3500 617-626-8000 ----------------------------------------------------------------------------------------------------------------------------Executive Office of Elder Affairs 1-800-243-4636, 1-800-872-0166 - TTY www.mass.gov Elder Affairs provides information and support services to elders and their families including home care, caregiver support, nutrition, health insurance counseling, Protective Services and housing options. Local Aging Services Access Points (ASAPs) and Councils on Aging (COAs) reach out to elders and their families to provide these services. (See Appendix C for ASAPs and Appendix B for COAs.) ----------------------------------------------------------------------------------------------------------------------------Bureau of Substance Abuse Services, Massachusetts Department of Public Health 1-800-327-5050 www.mass.gov/dph/bsas The Bureau of Substance Abuse Services oversees substance abuse prevention and treatment services in Massachusetts including licensing programs and counselors; funding and monitoring prevention and treatment services; providing access to treatment for the indigent and uninsured and tracking substance abuse trends in the state. ----------------------------------------------------------------------------------------------------------------------------Office of Medicaid 1-800-841-2900, 1-800-497-4648 -TTY www.mass.gov Medicaid administers the MassHealth program which offers a broad range of health care services, including mental health and substance services. These services include doctor visits, prescription medications, hospital stays, nursing facility services and in-home care for eligible recipients. ----------------------------------------------------------------------------------------------------------------------------Aging Services Access Points (ASAPs) 1-800-AGE-INFO (1-800-243-4636) www.800ageinfo.com There are 27 private, non-profit ASAPs in Massachusetts which provide information and referral services to elders and their families. ASAP case managers and nurses also visit elders in their homes to determine eligibility for various programs and services. Elders may be eligible for in-home support services such as a personal care homemaker or home delivered meals. Caregivers also may A GUIDE FOR MASSACHUSETTS ELDERS, FAMILIES AND CAREGIVERS
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be eligible to receive respite services to relieve the daily stress of caring for a family member. (See Appendix C for a list of ASAPs and telephone numbers.) ----------------------------------------------------------------------------------------------------------------------------Area Agencies on Aging (AAA) 1-800-AGE-INFO (1-800-243-4636) www.800ageinfo.com Twenty of the 27 ASAPs are also AAAs designated by the state to address the needs and concerns of all elders. AAAs focus on advocacy, planning for the needs of all elders in a geographic area and administering Older Americans Act (federal funds) such as Elder Abuse Prevention services and Nursing Home Ombudsman. (See Appendix C for a list of AAAs and telephone numbers.) ----------------------------------------------------------------------------------------------------------------------------Councils on Aging (COA) There is a COA in every city and town in Massachusetts. COAs provide many different services such as transportation, socialization, and companionship. For more information, contact the COA in your city or town. (See Appendix D for a list of COAs and telephone numbers.) ----------------------------------------------------------------------------------------------------------------------------Attorney General's Office ensures that the legal rights and safety of elders are enforced and protected. 1-888-AG-ELDER (1-888-243-5337) www.ago.state.ma.us ----------------------------------------------------------------------------------------------------------------------------Commission for the Blind provides rehabilitation and support services to blind individuals. 617-727-5550 www.mass.gov/mcb ----------------------------------------------------------------------------------------------------------------------------Commission for the Deaf and Hard of Hearing provides services and coordinates public policies, regulations, and programs for people who are deaf or hard of hearing. 1-800-882-1155, 1-800-530-7570-TTY www.mass.gov/mcdhh ----------------------------------------------------------------------------------------------------------------------------Department of Mental Retardation (DMR) provides assistance in job placement, transportation and housing, or intense levels of treatment, monitoring, and care for individuals with mental retardation. 617-727-5608 www.mass.gov/dmr ----------------------------------------------------------------------------------------------------------------------------Department of Public Health (DPH) provides information on a variety of healthy aging and chronic disease programs. DPH provides services to all Massachusetts residents, particularly the underserved, and promotes healthy people, families, communities, and environments through compassionate care, education and prevention. 617-624-6000 www.mass.gov/dph ----------------------------------------------------------------------------------------------------------------------------ELIMINATING BARRIERS TO MENTAL HEALTH TREATMENT
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Department of Transitional Assistance (DTA) administers public assistance programs for needy citizens of the Commonwealth. 617-348-8400 www.mass.gov/dta ----------------------------------------------------------------------------------------------------------------------------Department of Veterans' Services advocates on behalf of the Commonwealth's veterans, it protects them with support services, and directs an emergency assistance program for those veterans and their dependents in financial need. 617-210-5480 www.mass.gov ----------------------------------------------------------------------------------------------------------------------------Disabled Persons Protection Commission (DPPC) is an independent investigation and oversight agency that investigates and remediates suspected abuse of people with disabilities between the ages of 21 and 59 in the Commonwealth. 1-800-426-9009 www.mass.gov/dppc ----------------------------------------------------------------------------------------------------------------------------Division of Insurance regulates and monitors the insurance industry for the protection of Massachusetts' consumers. The Division responds to inquiries and assists consumers in resolving complaints against insurers, agents and brokers, and provides consumers with general insurance information. 617-521-7794 www.mass.gov/doi ----------------------------------------------------------------------------------------------------------------------------Executive Office of Health and Human Services (EOHHS) oversees health and human services for Massachusetts's residents. EOHHS plans, advocates, coordinates, and administers programs and polices that assure access to high quality health care, and enhances opportunities for older people to learn about and take responsibility for their own health. 617-573-1600 www.mass.gov ----------------------------------------------------------------------------------------------------------------------------Massachusetts Commission Against Discrimination (MCAD) enforces the Commonwealth's anti-discrimination laws in employment, housing, public accommodations, credit, mortgages, lending and education. MCAD works to eliminate discrimination and advance the civil rights of people through law enforcement and outreach. 617-994-6000 www.mass.gov/mcad ----------------------------------------------------------------------------------------------------------------------------Massachusetts Office on Disability (MOD) ensures equal access to facilities, services and programs for people with all types of physical, sensory, cognitive or other disabilities. 617-727-7440 www.mass.gov/mod ----------------------------------------------------------------------------------------------------------------------------Office of Consumer Affairs and Business Regulations protects Massachusetts' consumers by alerting them to disreputable practices and by promoting fair and honest competition. 1-888-283-3757 www.mass.gov ----------------------------------------------------------------------------------------------------------------------------A GUIDE FOR MASSACHUSETTS ELDERS, FAMILIES AND CAREGIVERS
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Office for Refugees and Immigrants (ORI) is responsible for the oversight of refugee resettlement, immigrant and newcomer programs. ORI assists refugees and immigrants to access benefits and services designed to assist them in adjusting and becoming financially self-sufficient. 617-727-7888 www.mass.gov/ori ----------------------------------------------------------------------------------------------------------------------------Secretary of State is the principal information officer for Massachusetts. The office's website provides information regarding public records and other areas that affect all Massachusetts residents. 1-800-392-6090, 617-878-3889-TTY www.sec.state.ma.us
Statewide Organizations and Associations 29
Alcoholics Anonymous (AA) is an organization of people who share their experiences, strength and hope with each other so that they may recover from alcoholism. 617-426-9444 www.aaboston.org ----------------------------------------------------------------------------------------------------------------------------AL ANON is an organization of relatives and friends of people with alcoholism who come together to support families of alcoholics. 508-366-0556 ----------------------------------------------------------------------------------------------------------------------------AIDS Action Committee of Massachusetts is committed to addressing the needs of those living with AIDS and HIV through service, education, advocacy, and outreach. 617-437-6200 www.aac.org ----------------------------------------------------------------------------------------------------------------------------Alzheimer's Association, Massachusetts Chapter is an advocacy group of family members, individuals with dementia and professionals dedicated to helping people with Alzheimer's disease. 1-800-272-3900 www.alzmass.org ----------------------------------------------------------------------------------------------------------------------------Disability Law Center provides legal advocacy and representation on disability issues to promote the rights of all people with disabilities to participate fully and equally in the social and economic life of Massachusetts. 1-800-872-9992 www.dlc-ma.org ----------------------------------------------------------------------------------------------------------------------------Home Care Alliance of Massachusetts is a statewide organization representing home health care agencies that provide nursing, physical therapy, occupational therapy, speech therapy and home health aide services to elders in their homes. 617-482-8830 www.hcalliancema.org ----------------------------------------------------------------------------------------------------------------------------Hospice and Palliative Care Federation of Massachusetts provides education and technical assistance, public awareness activities, and information and referral to the public, health care professionals, and patients and families regarding hospice care. 1-800-962-2973 www.hospicefed.org ELIMINATING BARRIERS TO MENTAL HEALTH TREATMENT
28
29
Massachusetts Association for Mental Health (MAMH) is a private non-profit Massachusetts corporation that advocates for community-based treatment and services for people with mental illnesses, and the promotion of mental health. 617-742-7452 www.mamh.org ----------------------------------------------------------------------------------------------------------------------------MassachusettsAssociation for the Blind represents the interests of blind and visually impaired individuals. 617-738-5110 www.mablind.org ----------------------------------------------------------------------------------------------------------------------------Mass Association of Councils on Aging and Senior Center Directors (MCOA) represents the 356 Councils on Aging and Senior Centers across the Commonwealth. It works to improve the quality of services provided to senior citizens by the Councils on Aging, Senior Centers and other social services providers. 413-527-6425 www.mcoaonline.com ----------------------------------------------------------------------------------------------------------------------------Massachusetts Association of Older Americans (MAOA) is a statewide advocacy and education organization advocating for a better life for elders, their families and future generations. 617-426-0804 ----------------------------------------------------------------------------------------------------------------------------Massachusetts Bar Association provides a lawyer referral service. 1-800-872-9992 www.masslawhelp.com ----------------------------------------------------------------------------------------------------------------------------Mass. Coalition for Suicide Prevention works to bring about awareness and mobilize community action in response to the public health crisis of suicide and self-injury in the Commonwealth. They will also provide referrals. It is not a crisis line. 617-817-1977 www.MassPreventsSuicide.org ----------------------------------------------------------------------------------------------------------------------------Mass Council of Home Care Aides represents Personal Care Homemaker Agencies in Massachusetts that provide homemaker and personal care to elders in their homes. 617-227-6641 ----------------------------------------------------------------------------------------------------------------------------Mass Home Care represents the 30 ASAPs and AAAs in Massachusetts that provide community support services to elders. Mass. Home Care's 1-800-AGE -INFO phone line and web site are a joint project with the Executive Office of Elder Affairs designed to assist consumers, families, and professionals seeking information and resources 781-272-7177 www.masshomecare.org ----------------------------------------------------------------------------------------------------------------------------Massachusetts Extended Care Federation represents more than 500 nursing home and residential care facilities, hospital-based transitional care units, assisted living facilities and retirement communities. It maintains a toll-free consumer line that provides information and referral services for its member A GUIDE FOR MASSACHUSETTS ELDERS, FAMILIES AND CAREGIVERS
30
31
organizations. 617-558-0202 www.mecf.org ----------------------------------------------------------------------------------------------------------------------------Massachusetts Psychological Association is a resource for psychologists, students and the general public to learn about psychology and human behavior. Important articles on research and current initiatives are available through the organization's website. 781-263-0080 www.masspsych.org ----------------------------------------------------------------------------------------------------------------------------Massachusetts Psychiatric Society (MPS) is an organization of Massachusetts psychiatrists. MPS is committed to providing exceptional medical and psychiatric care through accurate diagnosis and comprehensive treatment of mental disorders emotional illnesses. 781-237-8100 www.psychiatry-mps.org ----------------------------------------------------------------------------------------------------------------------------Mass Senior Action Council promotes the rights and dignity of all people, particularly vulnerable senior citizens by helping them to learn organizing skills, to develop new relationships and to build communities, working with people with disabilities, children and working families. 617-442-3330 www.masssenioraction.org ----------------------------------------------------------------------------------------------------------------------------Mental Health and Substance Abuse Corporations of Massachusetts is a statewide association representing mental health care and substance abuse providers dedicated to providing high quality, comprehensive, cost effective services in the community. 508-647-8385 www.mhsacm.org ----------------------------------------------------------------------------------------------------------------------------Massachusetts Immigrant and Refugee Advocacy Coalition (MIRA) advocates for the rights and opportunities of immigrants and refugees. MIRA advances this goal through education, training, leadership development, organizing, policy analysis and advocacy. 617-350-5480 www.miracoalition.org ----------------------------------------------------------------------------------------------------------------------------NAMI-MASS, the Massachusetts Chapter of the National Alliance for the Mentally Ill, is a grassroots educational and advocacy group dedicated to improving the quality of life for people affected by mental illness. 1-800-370-9085 www.namimass.org ----------------------------------------------------------------------------------------------------------------------------Narcotics Anonymous (NA) is an international, community-based association of recovering drug addicts. NA provides peer support to addicts who desire to be drug-free. 1-866-624-3578 www.centralmassna.org ----------------------------------------------------------------------------------------------------------------------------National Association of Social Workers provides a Social Work Therapy Referral Service serving most cities in Massachusetts. 1-888-294-6279 www.naswma.org ELIMINATING BARRIERS TO MENTAL HEALTH TREATMENT
30
Samaritans is a not-for-profit volunteer organization dedicated to reducing the incidence of suicide by befriending individuals in crisis and educating the community about effective prevention strategies. Listings in Boston and Fall River/New Bedford. 617-247-0220 www.samaritansofboston.org 1-866-508-4357 www.samaritans-fallriver.org
Federal Government Agencies
31
Administration on Aging (AOA) is an elder advocacy agency that focuses on increasing awareness of aging issues. AOA administers grants and programs to enhance the quality of life for elders and caregivers. 202-619-0724 www.aoa.dhhs.gov ----------------------------------------------------------------------------------------------------------------------------Centers for Medicare and Medicaid Services (CMS) administers the Medicare and Medicaid programs, which provide health care to elders, disabled persons and those with low or no income. 1-800-MEDICARE (1-800-633-4227), www.medicare.gov, 1-866-226-1819-TTY www.cms.gov ----------------------------------------------------------------------------------------------------------------------------U.S. Department of Health and Human Services (HHS) is the principal agency for protecting the health of all Americans and providing essential human services. HHS-funded services are provided at the local level by state or county agencies, or through private sector grantees. 1-877-696-6775 www.hhs.gov ----------------------------------------------------------------------------------------------------------------------------National Institutes of Health (NIH) is responsible for the administration of research programs and the development of advancements made towards finding cures for cancer, Alzheimer's disease, diabetes, HIV/AIDS and other diseases. 301-496-4000, 301-402-9612-TTY www.nih.gov ----------------------------------------------------------------------------------------------------------------------------National Institute on Aging conducts and supports biomedical, social and behavioral research related to problems older people encounter. 301-496-1752, 1-800-222-4225-TTY www.nia.nih.gov ----------------------------------------------------------------------------------------------------------------------------Substance Abuse and Mental Health Services Administration (SAMHSA) works to improve the quality and availability of substance abuse prevention, treatment and mental health services. It provides funding to support substance abuse and mental health services 1-800-789-2647 www.samhsa.gov ----------------------------------------------------------------------------------------------------------------------------Social Security Administration (SSA) oversees the administration of the Social Security program which provides people with benefits for retirement, survivor's benefits and disability A GUIDE FOR MASSACHUSETTS ELDERS, FAMILIES AND CAREGIVERS
32
insurance and the Supplemental Security Income (SSI) for certain low-income people. 1-800-772-1213 www.ssa.gov ----------------------------------------------------------------------------------------------------------------------------Department of Veterans Affairs offers a range of health, social and financial benefits available to qualifying veterans who have served our country in the military. 1-800-827-1000 www.va.gov
National Associations & Organizations
33
Alzheimer's Association is a non-profit organization that offers information and support services to people with Alzheimer's disease and their families. 1-800-272-3900 www.alz.org ----------------------------------------------------------------------------------------------------------------------------American Association for Geriatric Psychiatry (AAGP) enhances the knowledge base and standard of practice through education and research and advocates for meeting the mental health needs of older Americans. 301-654-7850 www.aagpgpa.org ----------------------------------------------------------------------------------------------------------------------------AARP is a non-partisan membership organization for people 50 and older that provides benefits, services and information resources. 1-888-687-2277 www.aarp.org ----------------------------------------------------------------------------------------------------------------------------Gray Panthers is an advocacy organization that concentrates on social and economic issues and common problems faced by retirees. Local chapters organize younger and older people to work on issues and provide education to the public. 1-800-280-5362 www.graypanthers.org ----------------------------------------------------------------------------------------------------------------------------National Association of Area Agencies on Aging (N4A) is an umbrella organization for the federally funded Area Agencies on Aging and the Title VI Native American aging programs. N4A advocates and promotes access to resources that give older people choices in order to live their lives with dignity. 202-872-0888 www.n4a.org ----------------------------------------------------------------------------------------------------------------------------National Association for Home Care and Hospice (NAHC) represents home care and hospice the agencies that deliver direct care to elders and disabled citizens. 202-547-7424 www.nahc.org ----------------------------------------------------------------------------------------------------------------------------National Association of Professional Geriatric Care Managers (GCM) is an association of professional practitioners whose purpose is the development, advancement and promotion of humane and dignified social, psychological and health care for the elderly and their families through counseling, treatment and the delivery of services by qualified, certified providers. 520-881-8008 www.caremanager.org ELIMINATING BARRIERS TO MENTAL HEALTH TREATMENT
32
33
National Association of Social Workers (NASW) is a membership organization that promotes, advocates, develops and protects social workers and the practice of social work. 202-408-8600 www.naswdc.org -----------------------------------------------------------------------------------------------------------------------------National Association of State Units on Aging (NASUA) is a membership organization comprised of the 57 state and territorial government agencies on aging with a mission to advance social, health and economic policies to meet the needs of older people. 202-898-2578 www.nasua.org -----------------------------------------------------------------------------------------------------------------------------National Caucus and Center on Black Aged (NCBA) works to eliminate obstacles to fairness and equal access for low-income African American and minority senior citizens focusing on housing, employment and health promotion/disease prevention. 202-637-8400 www.ncba-aged.org -----------------------------------------------------------------------------------------------------------------------------National Center on Elder Abuse is a national resource for elder rights, law enforcement and legal professionals, public policy leaders and researchers to promote understanding, knowledge sharing and action on elder abuse, neglect, and exploitation. 202-898-2586 www.elderabusecenter.org -----------------------------------------------------------------------------------------------------------------------------National Coalition on Mental Health and Aging (NCMHA) provides opportunities for professional, consumer and government organizations to work together towards improving the availability and quality of mental health treatment and prevention strategies for older Americans and their families through education, research and increased public awareness. 202-336-6135 www.ncmha.org -----------------------------------------------------------------------------------------------------------------------------National Council on the Aging (NCOA) provides information, training, technical assistance, advocacy and leadership in all aspects of aging services and issues. Members include senior centers, adult day service centers, area agencies on aging, faith congregations, senior housing facilities, employment services and other consumer organizations. 202-479-1200 www.ncoa.org -----------------------------------------------------------------------------------------------------------------------------National Family Caregivers Association (NFCA) provides advocacy, support and information to those caring for older, disabled and chronically ill older people and is committed to improving the overall quality of life for caregiving families. 1-800-896-3650 www.thefamilycaregiver.org -----------------------------------------------------------------------------------------------------------------------------Older Women's League (OWL) is a grassroots organization of older women dedicated to improving the quality of life through research, education and advocacy. 1-800-825-3695 www.owl-national.org
A GUIDE FOR MASSACHUSETTS ELDERS, FAMILIES AND CAREGIVERS
34
Appendix A: Emergency Service Programs (ESP) Emergency Service: 24-Hours a Day/7-Days a Week
There are mental health agencies throughout Massachusetts that provide crisis/emergency services to all individuals, regardless of age or insurance coverage. The emergency services may be provided in a person's home, in a clinic or in a hospital.
35
The following is a list of Aging Services Access Points (ASAP)/ Area Agencies on Aging and Corresponding ESP Provider by Massachusetts Behavioral Health Partnership Region. The listing includes cities and towns covered in each region
Aging Services Access Points (ASAP)
Corresponding ESP Provider
Service Area
Boston Senior Home Care
Boston Emergency Services
Beacon Hill/WestEnd,
110 Chauncy Street
Team (B.E.S.T.)
Charlestown, Chinatown,
Boston, MA 02111
Boston, MA
Columbia Point,
(617) 451-6400
(800) 981-4357
Dorchester, East Boston,
TTY: (617) 695-0437
Fax: (617) 414-8306
East Mattapan, North
Fax: (617) 451-6631
End, and South Boston
(617) 292-6211 BOSTON ELDER INFO. Central Boston Elder Services, Inc.
Boston Emergency Services
Allston, Back Bay,
2315 Washington Street
Team (B.E.S.T.)
Brighton, Fenway,
Boston, MA 02119
Boston, MA
Jamaica Plain, North
(617) 277-7416 - 7818
(800) 981-4357
Dorchester, Parker Hill,
TDD: (617) 277-6691
Fax: (617) 414-8306
and Roxbury
*Chelsea/Revere/Winthrop Elder
Boston Emergency Services
Chelsea, Revere,
Services
Team (B.E.S.T.)
Winthrop
100 Everett Avenue, Unit 10
Boston, MA
Post Office Box 6427
(800) 981-4357
Chelsea, MA 02150-0008
Fax: (617) 414-8306
Fax: (617) 277-2005
617-884-2500 Fax: 617-884-7988
ELIMINATING BARRIERS TO MENTAL HEALTH TREATMENT
Aging Services Access Points (ASAP)
Corresponding ESP Provider
Service Area
*Commission on Affairs of the
Boston Emergency Services
City of Boston
Elderly
Team (B.E.S.T.)
Boston City Hall
Boston, MA
One City Hall Plaza/ Room 271
(800) 981-4357
Boston, MA 02201
Fax: (617) 414-8306
(617) 635-4366; Hot Line: 635-4646 TDD: (617) 635-4599 Fax: (617) 635-3213 36 *Commission on Affairs of the
Boston Emergency Services
Hyde Park, South
Elderly
Team (B.E.S.T.)
Jamaica Plain,
Boston City Hall
Boston, MA
Roslindale, West
One City Hall Plaza/ Room 271
(800) 981-4357
Roxbury, and West
Boston, MA 02201
Fax: (617) 414-8306
Mattapan
*Health & Social Services
Riverside Community Care
Canton, Dedham,
Consortium Inc. (HESSCO)
190 Lenox Street
Foxborough, Medfield,
One Merchant Street
Norwood, MA 02062
Millis, Norfolk, Norwood,
Sharon, MA 02067
(781) 769-8674
Plainville, Sharon,
(781) 784-4944
(800) 529-5077
Walpole, Westwood and
Toll Free: 800-462-5221
Fax: (781) 769-6717
Wrentham
*Minuteman Senior Services, Inc.
The Edinburg Center
Acton, Arlington,
24 Third Avenue
Formerly Center for MH & MR
Bedford, Boxborough,
Burlington, MA 01803
1040 Waltham Street
Burlington, Carlisle,
(781) 272-7177
Lexington, MA 02421
Concord, Harvard,
TDD: (617) 272-3114
(800) 540-5806
Lexington, Lincoln,
Fax: (781) 229-6190
Fax: (781) 860-7636
Littleton, Maynard, Stow,
(617) 635-4366; Hot Line: 635-4646 TDD: (617) 635-4599 Fax: (617) 635-3213
Fax: (781) 784-4922
Wilmington, Winchester, and Woburn
A GUIDE FOR MASSACHUSETTS ELDERS, FAMILIES AND CAREGIVERS
Aging Services Access Points (ASAP)
Corresponding ESP Provider
Service Area
*Somerville/Cambridge Elder
The Cambridge Hospital
Cambridge and
Services, Inc.
l493 Cambridge Street
Somerville
61 Medford Street
Cambridge, MA 02139
Somerville, MA 02143-3429
(617) 665-1560
(617) 628-2601; 2602
Fax: (617) 665-1843
TDD: (617) 628-1705 Fax: (617) 628-1085 37
*South Shore Elder Services, Inc.
South Shore Mental Health
Braintree, Cohasset,
159 Bay State Dr.
Center (SSMHC)
Hingham, Holbrook, Hull,
Braintree, MA 02184
460 Quincy Ave
Milton, Norwell, Quincy,
(781) 848-3910
Quincy, MA 02169
Randolph, Situate, and
TDD: (781) 356-1992
(800) 528-4890
Weymouth
Fax: (781) 843-8279
Fax: (617) 479-0356
*Springwell
The Edinburg Center
Belmont, Brookline,
125 Walnut Street
Formerly Center for MH & MR
Needham, Newton,
Watertown, MA 02472
1040 Waltham Street
Waltham, Watertown,
617-926-4100, TDD: (617) 926-5717
Lexington, MA 02421
Wellesley, and Weston
www.springwell.com
(800) 540-5806
Fax: (617) 926-9897
Fax: (781) 860-7636
*Elder Services of Berkshire County, Inc.
The Brien Center for Mental
Adams, Alford, Becket,
66 Wendell Avenue
Health & Substance Abuse
Cheshire, Clarksburg,
Pittsfield, MA 01201
Services
Dalton, Egremont, Florida,
(413) 499-0524
(Formerly MHSAB)
Great Barrington, Hancock,
Toll Free: (800) 544-5242
333 East Street
Hinsdale, Lanesborough,
Fax: (413) 442-6443
Pittsfield, MA 01201
Lee, Lenox, Monterey,
(413) 499-0412
Mount Washington, New
(800) 252-0227
Ashford, New Marlborough,
Fax: (413) 499-0995
North Adams, Otis, Peru, Pittsfield, Richmond,
North
Sandisfield, Savoy,
28 Marshall Street
Sheffield, Stockbridge,
North Adams, MA 01247
Tyringham, Washington,
(413) 664-4541
West Stockbridge, Williamstown, and Windsor
ELIMINATING BARRIERS TO MENTAL HEALTH TREATMENT
Aging Services Access Points (ASAP)
Corresponding ESP Provider
Service Area
*Franklin County Home Care
Clinical & Support Options,
Ashfield, Athol,
Corporation
Inc
Bernardston, Buckland,
330 Montague City Road, Suite #1
140-144 High Street
Charlemont, Colrain,
Turners Falls, MA 01376-2530
Greenfield, MA 01301
Conway, Deerfield, Erving,
(413) 773-5555
(800) 562-0112
Gill, Greenfield, Hawley,
(800) 732-4636
Fax: (413) 773-8429
Heath, Leverett, Leyden,
TDD: (413) 772-6566
Monroe, Montague, New
Fax: (413) 772-1084
Salem, Northfield, Orange, Petersham, Phillipston, Rowe, Royalston, Shelburne, Shutesbury, Sunderland, Warwick, Wendell, Whately
*Greater Springfield Senior
Behavioral Health Network-
Brimfield, East
Services, Inc.
Springfield
Longmeadow, Hampden,
66 Industry Avenue Suite 9
503 State Street
Holland, Longmeadow,
Springfield, MA 01104
Springfield, MA 01109
Palmer, Springfield,
(413) 781-8800
(413) 733-6661
Wales, Wilbraham
(800) 649-3641
Fax: (413) 733-7841
TDD: (413) 272-0399 Fax: (413) 781-0632
Carson Center for Human
Agawam and West
Services
Springfield
77 Mill Street Westfield, MA 01085 (413) 568-6386 Fax: (413) 572-4144 Behavioral Health Network-
Monson and Palmer
Holyoke 40 Bobala Drive Holyoke, MA 01040 (800) 437-5922 (413) 536-2251 Fax: (413) 532-8271
A GUIDE FOR MASSACHUSETTS ELDERS, FAMILIES AND CAREGIVERS
38
Aging Services Access Points (ASAP)
Corresponding ESP Provider
Service Area
*Highland Valley Elder Services, Inc.
ServiceNet Emergency
Amherst, Blandford,
320 Riverside Drive, Suite B
Services
Chesterfield, Cummington,
Florence, MA 01062-2700
131 King Street
Easthampton, Goshen,
(413) 586-2000
Northampton, MA 01060
Hadley, Hatfield, Middlefield,
Toll Free: (800) 322-0551
(413) 586-5555
Northampton, Pelham,
TDD: (413) 585-8160
(800) 322-0424
Plainfield, Southampton,
Fax: (413) 584-7076
Fax: (413) 585-1352
Westhampton, Williamsburg, and Worthington
39 Carson Center for Human
Chester, Granville,
Services
Huntington, Montgomery,
77 Mill Street
Russell, Southwick, Tolland,
Westfield, MA 01085
and Westfield
(413) 568-6386 Fax: (413) 572-4144 *WestMass ElderCare, Inc.
Behavioral Health Network-
Belchertown, Holyoke,
4 Valley Mill Road
Holyoke
Ludlow, South Hadley,
Holyoke, MA 01040
40 Bobala Drive
Ware, Chicopee, and
(413) 538-9020
Holyoke, MA 01040
Granby
Hot Line & TDD: (800) 462-2301
(800) 437-5922
Fax: (413) 538-6258
(413) 536-2251 Fax: (413) 532-8271
*Baypath Elder Services, Inc.
AdvocatesPsychiatric
Ashland, Dover,
354 Waverly Street
Emergency Services
Framingham, Holliston,
Framingham, MA 01702-7079
27 Hollis Street
Hopkinton, Hudson,
(508) 872-1866
Framingham, MA 01702
Marlborough, Natick,
Toll Free: (800) 287-7284
(800) 640-5432
Northborough, Sherborn,
TTY: (508) 872-5012
(508) 872-3333
Southborough, Sudbury,
Fax: (508) 872-3325
Fax: (508) 875-2600
Wayland, and Westborough
*Central Mass Agency on Aging, Inc. UMASS Memorial Medical Center 360 West Boylston Street 55 Lake Avenue West Boylston, MA 01583
NorthWorcester, MA 01655
(508) 852-5539, (800) 244-3032
(508) 856-3562
TDD: (508) 852-5539, Fax: (508) 852-5425
Fax: (508) 856-1695
ELIMINATING BARRIERS TO MENTAL HEALTH TREATMENT
Worcester, Montachusett and Tri-Valley
Aging Services Access Points (ASAP)
Corresponding ESP Provider
Service Area
Elder Services of Worcester Area, Inc.
UMASS Memorial Medical Center
Auburn, Boylston, Holden,
411 Chandler Street
55 Lake Avenue
Leicester, Paxton,
Worcester, MA 01602
NorthWorcester, MA 01655
Shrewsbury, West
(508) 756-1545
(508) 856-3562
Boylston,
TDD: (508) 792-4541
Fax: (508) 856-1695
Fax: (508) 754-7771 North Central Human Services
WorcesterBarre,
31 Lake Street
Hardwick, New Braintree,
Gardner, MA 01440
Oakham, and
(978) 632-9400, (800) 379-9404
RutlandGrafton and
Fax: (978) 630-3085
Millbury
Blackstone Valley Emergency Monson and Palmer ServicesRiverside 206 Milford Street Upton, MA 01568 (508) 634-3420, (800) 294-4665 Fax: (508) 529-7001 Montachusett Home Care Corporation North Central Human Services Crossroads Office Park 31 Lake Street
Ashby, Ayer, Berlin,
680 Mechanic St. - Suite 120
Gardner, MA 01440
Fitchberg, Groton,
Leominster, MA 01453-4402
(978) 632-9400
Lancaster, Leominster,
(978) 537-7411(800) 734-7312
(800) 379-9404
Lunenberg, Pepperell,
TDD: (978) 534-6273
Fax: (978) 630-3085
Shirley, Sterling, and
Bolton, Clinton,
Townsend
Fax: (978) 537-9843 Community HealthLink, Inc.
Ashburnham, Gardner,
The Lipton Center
Hubbardston, Princeton,
45 Summer Street
Templeton, Westminster,
Leominster, MA 01453
and Winchendon
(978) 534-6116 (800) 977-5555 Fax: (978) 534-3294
A GUIDE FOR MASSACHUSETTS ELDERS, FAMILIES AND CAREGIVERS
40
Aging Services Access Points (ASAP)
Corresponding ESP Provider
Tri-Valley Elder Services, Inc. 251 Main Street
Blackstone Valley Emergency Bellingham, Blackstone, Douglas, East Douglas, Services
Webster, MA 01570
Riverside
Franklin, Hopedale,
(508) 949-6640
206 Milford Street
Medway, Mendon, Milford,
(800) 286-6640
Upton, MA 01568
Millville, Northbridge,
TDD: (508) 949-6654
(508) 634-3420
Sutton, Upton, and
Fax: (508) 949-6651
(800) 294-4665
Uxbridge
Service Area
Fax: (508) 529-7001 41 Harrington Memorial Hospital Brookfield, Charlton, Dudley, East Brookfield, 100 South Street Southbridge, MA 01550
North Brookfield, Oxford,
(508) 765-9771 X 2580
Southbridge, Spencer,
Fax: (508) 765-3147
Sturbridge, Warren, Webster, West Brookfield, and Whitinsville
*Elder Services of Merrimac
North Essex Mental Health
Amesbury, Billerica,
Valley, Inc.
Center
Boxford, Georgetown,
Riverwalk, Building #5
HES
Groveland, Haverhill,
360 Merrimack Street
60 Merrimack Street
Merrimac, Newbury,
Lawrence, MA 01843
Haverhill, MA 01830
Newburyport, Rowley,
(978) 683-7747
(800) 281-3223
Salisbury, and West
(800) 892-0890
Fax: (978) 521-7767
Newbury
Choate Emergency Services
Chelmsford, Dracut,
391 Varnum Ave
Dunstable, Lowell,
Lowell, MA 01854
Tewksbury,
(800) 830-5177
Tyngsborough, and
Fax: (978) 322-5134
Westford
HES-Lawrence30
Andover, Lawrence,
General Street
Methuen, and North
Lawrence, MA 01841
Andover
TDD: (800) 924-4222 Fax: (978) 687-1067
(877) 255-1261 Fax: (978) 682-9333
ELIMINATING BARRIERS TO MENTAL HEALTH TREATMENT
Aging Services Access Points (ASAP)
Corresponding ESP Provider
Service Area
*Greater Lynn Senior Services, Inc.
Tri-City Mental Health Center
Lynn, Lynnfield, Nahant,
8 Silsbee Street
95 Pleasant Street
Saugus, and Swampscott
Lynn, MA 01901
Lynn, MA 01901
(781) 599-0110, TDD: (781) 477-9632
(800) 988-1111, (781) 596-9222
Fax: (781) 592-7540
Fax: (781) 581-9876
*Mystic Valley Elder Services, Inc.
173 Chelsea Street
Everett, Malden,
19 Riverview Business Park
Everett, MA 02149
Medford, Melrose, North
300 Commercial Street
(800) 988-1111, (781) 596-9222 Reading, Reading, Stoneham, and Fax: (781) 581-9876
Malden, MA 02148
Wakefield
(781) 324-7705, TDD (781) 321-8880 Fax: (781) 324-1369
26 Princess Street Wakefield, MA 01880 (800) 988-1111, (781) 596-9222 Fax: (781) 581-9876
152 Sylvan Street
Health & Education Services (HES) Danvers, Marblehead, Middleton, Peabody, and 131 Rantoul Street
Danvers, MA 01923
Beverly, MA 01915
(978) 750-4540TDD: (978) 624-2244
(866) 523-1216, (978) 524-7107
Fax: (978) 750-8053, www.nselder.org
Fax: (978) 524-7106
*SeniorCare, Inc. 5 Blackburn Center
Health & Education Services (HES) Beverly, Essex, Gloucester, Hamilton, 131 Rantoul Street
Gloucester, MA 01930-2259
Beverly, MA 01915
Ipswich, Manchester,
(978) 281-175O, TDD: (978) 468-1193
(866) 523-1216, (978) 524-7107
Rockport, Topsfield, and
Fax: (978) 281-1753
Fax: (978) 524-7106
Wenham
*Bristol Elder Services, Inc.
Taunton/Attleboro Emergency
Attleboro, Berkley,
182 North Main Street
Service
Dighton, Mansfield,
Fall River, MA 02720
108 West Main St., Bldg. #2
North Attleboro, Norton,
(508) 675-2101, (800) 427-2101
Norton, MA 02766
Raynham, Rehoboth,
Fax: (508) 679-0320
(508) 285-9400, (800) 660-4300
Seekonk, and Taunton
*North Shore Elder Services, Inc.
Salem
Fax: (508) 285-6573
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Aging Services Access Points (ASAP)
Corresponding ESP Provider
Service Area
*Bristol Elder Services, Inc.
Corrigan Mental Health Center
Fall River, Freetown, North
182 North Main Street
49 Hillside Street
Westport, Somerset,
Fall River, MA 02720
Fall River, MA 02720
Swansea, and Westport
(508) 675-2101, (800) 427-2101
(508) 235-7277
Fax: (508) 679-0320
Fax: (508) 235-7345
*Coastline Elderly Services, Inc.
Child and Family Services, Inc.
Acushnet, Dartmouth,
1646 Purchase Street
543 North Street
Fairhaven, Gosnold,
New Bedford, MA 02740
New Bedford, MA 02740
Marion, Mattapoisett, New
(508) 999-6400, TDD: (508) 994-4265
(877) 996-3154
Bedford, North Dartmouth,
Fax: (508) 993-6510
Fax: (508) 991-8082
and Rochester
*Elder Services of Cape Cod
Cape Cod
Barnstable, Bourne,
and the Islands, Inc.
270 Communication Way,
Brewster, Buzzards Bay,
68 Route 134
Unit DE
Centerville, Chatham,
South Dennis, MA 02660-3774
Hyannis, MA 02601
Chilmark, Dennis,
(508) 394-4630
(508) 778-4627(800) 322-1356
Eastham, Edgartown,
800-244-4630 (on Cape Cod)
Fax: (508) 790-0899
Falmouth, Gay Head,
800-442-4492 (off Cape)
Harwich, Hyannis, Mashpee, Nantucket, Oak Bluffs, Orleans, Provincetown, Sandwich, Tisbury, Vineyard Haven, Wellfleet, and Yarmouth
Old Colony Elderly Services, Inc.
Brockton Multi-Service Center
Abington, Avon, Bridgewater,
144 Main St., P.O. Box 4469-02303
165 Quincy Street
Brockton, East Bridgewater,
Brockton, MA 02301
Brockton, MA 02302
Easton, North Easton,
(508) 584-1561; 586-3700
(508) 897-2100
Rockland, Stoughton, West
(800) 242-0246
Fax: (508) 586-5117
Bridgewater, and Whitman
Family Continuity Program,
Carver, Duxbury, Halifax,
Inc.
Hanover, Hanson, Kingston,
118 Longpond Road, Suite 100
Lakeville, Marshfield,
Plymouth, MA 02360
Middleborough, Pembroke,
(800) 469-9888
Plymouth, Plympton, and
Fax: (508) 747-7838
Wareham
TDD: (508) 587-0280 Fax: (508) 584-6005; 897-0031
ELIMINATING BARRIERS TO MENTAL HEALTH TREATMENT
Aging Services Access Points (ASAP)
Corresponding ESP Provider
Service Area
*Old Colony Planning Council
Brockton Multi-Service Center
Abington, Avon, Bridgewater,
70 School Street
165 Quincy Street
Brockton, East Bridgewater,
Brockton, MA 02301
Brockton, MA 02302
Easton, North Easton,
(508) 583-1833
(508) 897-2100
Rockland, Stoughton, West
Fax: (508) 559-8768
Fax: (508) 586-5117
Bridgewater, and Whitman
Family Continuity Program, Inc.
Carver, Duxbury, Halifax,
118 Longpond Road, Suite 100
Hanover, Hanson, Kingston,
Plymouth, MA 02360
Lakeville, Marshfield,
(800) 469-9888,
Middleborough, Pembroke,
Fax: (508) 747-7838
Plymouth, Plympton, and Wareham
The following is a listing of the Emergency Service Programs organized by DMH Area. Metro Boston Area: Cambridge/Somerville 617-665-1560 617-665-1572 Boston 800-981-HELP Metro Suburban Area: Lexington 800-540-5806 Framingham 508-872-3333 Norwood 781-769-8674 Quincy 617-774-6038 North East Massachusetts Area: Beverly/Gloucester 978-524-7107 Haverhill 987-521-3126 800-281-3223 Lawrence 978-683-3128 Lowell 978-322-5120 800-830-5177 Lynn 781-596-9222 800-988-1111 Everett 781-397-2050 800-988-1111
Central Massachusetts Area: Leominster 978-534-3372 800-977-5555 Gardner 978-632-9400 Upton 508-634-3420 Southbridge 508-765-9771 ext. 2580 Worcester 508-856-3562 Western Massachusetts Area: Pittsfield 413-499-0412 North Adams 413-664-4541 Northampton 413-586-5555 Holyoke 413-536-2251 Springfield 413-733-6661 Westfield 413-566-6386 Southeastern Massachusetts Area: Brockton 508-897-2100 Hyannis 508-778-4627 Fall River 508-235-7200 New Bedford 508-996-3154 Plymouth 800-469-9888 Norton 508-285-9400 800-660-4300
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Appendix B: Hospitals with Gero-Psychiatric Units in Massachusetts
35 45
Carney Hospital 2100 Dorchester Avenue Dorchester, MA 02124 617-296-4000
Morton Hospital 88 Washington Street Taunton, MA 02780 508-828-7441
Caritas Good Samaritan Medical Center 235 North Pearl Street Brockton, MA 02301 508-427-3000
Quincy Medical Center 114 Whitwell Street Quincy, MA 02159 617-376-5431
Caritas Norwood Hospital 800 Washington Street Norwood, MA 02062 781-769-4000
UMass Memorial Health Care @ Clinton Hospital 201 Highland Street Clinton, MA 01510 978-368-3000, 3836
Henry Heywood Memorial Hospital 242 Green Street Gardner, MA 01440 978-632-3420
Pembroke Hospital 199 Oak Street Pembroke, MA 02359 781-826-8161
Lawrence Memorial Hospital 200 Governors Avenue Medford, MA 02155 781-306-6000
Providence Hospital 1233 Main Street Holyoke, MA 01040 413-536-5111
McLean Hospital 115 Mill Street Belmont, MA 02478 617-855-2000
Somerville Hospital 230 Highland Avenue Somerville, MA 02143 617-666-4400
Merrimack Valley Hospital 140 Lincoln Avenue Haverhill, MA 01830 978-374-2000
Union Medical Center 500 Lynnfield Street Lynn, MA 01904 781-581-9200
Mount Auburn Hospital 330 Mt. Auburn Street Cambridge, MA 02138 617-492-3500 x4231 ELIMINATING BARRIERS TO MENTAL HEALTH TREATMENT
Appendix C: Aging Services Access Points and Area Agencies on Aging Baypath Home and Community Services *
Southborough 1-800-287-7284
Serving: Ashland, Dover, Framingham, Holliston, Hopkinton, Hudson, Marlborough, Natick, Northborough, Sherborn, Southborough, Sudbury, Wayland, Westborough Boston Senior Home Care
Boston 617-451-6400
Serving: Beacon Hill/West End, Charlestown, Chinatown, Columbia Point, Dorchester, East Boston, East Mattapan, North End, South Boston Bristol Elder Services *
Fall River 1-800-427-2101
Serving: Attleboro, Berkley, Dighton, Fall River, Freetown, Mansfield, North Attleboro, North Westport, Norton, Raynham, Rehoboth, Seekonk, Somerset, Swansea, Taunton, Westport Central Boston Elder Services
Boston 617-277-7416
Serving: Allston, Back Bay, Brighton, Fenway, Jamaica Plain, North Dorchester, Parker Hill, Roxbury Central Area Agency on Aging
West Boylston 1-800-244-3032
Serving: Tri-ValleyElder Services, Elder Services of Worcester and Montachusett Home Care areas Chelsea/Revere/Winthrop Home Care Center *
Revere 617-884-2500
Serving: Chelsea, Revere, Winthrop
* ASAP & AAA
** AAA only
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Coastline Elderly Services *
New Bedford 508-999-6400
Serving: Acushnet, Dartmouth, Fairhaven, Gosnold, Marion, Mattapoisett, New Bedford, North Dartmouth, Rochester Commission on Affairs of the Elderly **
Boston 617-635-4366
Serving: Boston including Boston Senior Home Care, Central Boston Elder Services and ETHOS areas 47
Elder Services of Berkshire County *
Pittsfield 1-800-544-5242
Serving: Adams, Alford, Becket, Cheshire, Clarksbury, Dalton, Egremont, Florida, Great Barrington, Hancock, Hinsdale, Lanesborough, Lee, Lenox, Monterey, Mount Washington, New Ashford, New Marlborough, North Adams, Otis, Peru, Pittsfield, Richmond, Sandisfield, Savoy, Sheffield, Stockbridge, Tyringham, Washington, West Stockbridge, Willamstown, Windsor Elder Services of Cape Cod and Islands * Serving: Barnstable, Bourne, Brewster, Buzzards Bay, Centerville, Chatham, Chilmark, Dennis, Eastham, Edgartown, Falmouth, Gay Head, Harwich, Hyannis, Mashpee, Nantucket, Oak Bluffs, Orleans, Provincetown, Sandwich, Tisbury, Truro, Vineyard Haven, Wellfleet, West Tisbury, Yarmouth Elder Services of the Merrimack Valley * Serving: Amesbury, Andover, Billerica, Boxford, Chelmsford, Dracut, Dunstable, Georgetown, Groveland, Haverhill, Lawrence, Lowell, Merrimac, Methuen, Newbury, Newburyport, North Andover, Rowley, Salisbury, Tewksbury, Tyngsborough, Westford, West Newbury
* ASAP & AAA
** AAA only
ELIMINATING BARRIERS TO MENTAL HEALTH TREATMENT
South Dennis 508-394-3712 1-800-244-4630 (Cape) 1-800-442-4492 (off Cape)
Lawrence 1-800-892-0890
Elder Services of Worcester Area
Worcester 508-756-1545
Serving: Auburn, Barre, Boylston, Grafton, Hardwick, Holden, Leicester, Millbury, New Braintree, Oakham, Paxton, Rutland, Shrewsbury, West Boylston, Worcester ETHOS
Jamaica Plain 617-522-6700
Serving: Hyde Park, South Jamaica Plain, Roslindale, West Roxbury, West Mattapan Franklin County Homecare Corporation *
Turners Falls 1-800-732-4636
Serving: Ashfield, Athol, Bernardston, Buckland, Charlemont, Colrain, Conway, Deerfield, Erving, Gill, Greenfield, Hawley, Heath, Leverett, Leyden, Monroe, Montague, New Salem, Northfield, Orange, Petersham, Phillipston, Rowe, Royalston, Shelburne, Shutesbury, Sunderland, Warwick, Wendell, Whatley Greater Lynn Senior Services *
Lynn 781-599-0110
Serving: Lynn, Lynnfield, Nahant, Saugus, Swampscott Greater Springfield Senior Services *
Springfield 1-800-649-3641
Serving: Agawam, Brimfield, East Longmeadow, Hampden, Holland, Longmeadow, Monson, Palmer, Springfield, Wales, West Springfield, Wilbraham HESSCO *
Sharon 1-800-462-5221
Serving: Canton, Dedham, Foxborough, Medfield, Millis, Norfolk, Norwood, Plainville, Sharon, Walpole, Westwood, Wrentham
* ASAP & AAA
** AAA only
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Highland Valley Elder Services *
Northhampton 1-800-322-0551
Serving: Amherst, Blandford, Chester, Chesterfield, Cummington, Easthampton, Goshen, Granville, Hadley, Hatfield, Huntington, Middlefield, Montgomery, Northhampton, Pelham, Plainfield, Russell, Southhampton, Southwick, Tolland, Westfield, Westhampton, Williamsburg, Worthington Minuteman Home Care * 49
Burlington 617-272-7177
Serving: Acton, Arlington, Bedford, Boxborough, Burlington, Carlisle, Concord, Harvard, Lexington, Lincoln, Littleton, Maynard, Stow, Wilmington, Winchester, Woburn Montachusett Home Care Corporation
38
Leominster 1-800-734-7312
Serving: Ashburnham, Ashby, Ayer, Berlin, Bolton, Clinton, Fitchburg, Gardner, Groton, Hubbardston, Lancaster, Leominster, Lunenberg, Pepperell, Princeton, Shirley, Sterling, Templeton, Townsend, Westminster, Winchendon Mystic Valley Elder Services *
Malden 781-324-7705
Serving: Everett, Malden, Medford, Melrose, North Reading, Reading, Stoneham, Wakefield North Shore Elder Services *
Danvers 978-750-4540
Serving: Danvers, Marblehead, Middleton Peabody, Salem Old Colony Planning Council **
Brockton 508-583-1833
Serving: Old Colony Elder Services area Old Colony Elderly Services Serving: Abington, Avon, Bridgewater, Brockton, Carver, Duxbury, East Bridgewater, Easton, Halifax, Hanover, * ASAP & AAA
** AAA only
ELIMINATING BARRIERS TO MENTAL HEALTH TREATMENT
Brockton 1-800-242-0246
Hanson, Kingston, Lakeville, Marshfield, Middleborough, North Easton, Pembroke, Plymouth, Plympton, Rockland, Stoughton, Wareham, West Bridgewater, Whitman SeniorCare, Inc. *
Gloucester 978-281-1750
Serving: Beverly, Essex, Gloucester, Hamilton, Ipswich, Manchester, Rockport, Topsfield, Wenham Somerville/Cambridge Elder Services * 39
Somerville, 617-628-2601
Serving: Cambridge and Somerville South Shore Elder Services *
Braintree 781-848-3910
Serving: Braintree, Cohasset, Hingham, Holbrook, Hull, Milton, Norwell, Quincy, Randolph, Scituate, Weymouth Springwell *
Watertown 617-926-4100
Serving: Belmont, Brookline, Needham, Newton, Waltham, Watertown, Wellesley, Weston Tri-Valley Elder Services
Webster 1-800-286-6640
Serving: Bellingham, Blackstone, Brookfield, Charlton, Douglas, Dudley, East Brookfield, East Douglas, Franklin, Hopedale, Medway, Mendon, Milford, Millville, Northbridge, North Brookfield, Oxford, Southbridge, Spencer, Sturbridge, Sutton, Upton, Uxbridge, Warren, Webster, West Brookfield, Whitinsville WestMass ElderCare *
Holyoke 413-538-9020
Serving: Belchertown, Chicopee, Granby, Holyoke, Ludlow, South Hadley, Ware * ASAP & AAA
** AAA only
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Appendix D: Councils on Aging
51
40
ELIMINATING BARRIERS TO MENTAL HEALTH TREATMENT
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ELIMINATING BARRIERS TO MENTAL HEALTH TREATMENT
Appendix E: Terms and Definitions Advance Directive is a document written by a person to state his or her preferences about medical care and treatment before an illness or injury occurs. This enables a person to choose a decision maker before becoming ill and to define and communicate values and wishes regarding care and treatment before becoming unable to make health care decisions.
47
Anxiety disorders range from feelings of uneasiness to immobilizing bouts of terror. Most people experience anxiety in anticipation of a real situation. However, an anxiety disorder is characterized by unwarranted worries and avoiding everyday activities. Bipolar Disorder is characterized by extreme mood swings and periods of normal behavior causing shifts in a person's mood, energy, and ability to function from a depressive state to a manic state. The manic phase may include decreased need for sleep, reckless behavior, high energy, exaggerated self-esteem and rapid speech. Borderline Personality Disorder (BPD) is characterized by pervasive instability in moods, interpersonal relationships, self-image, and behavior. Clinical Nurse Specialist is a licensed advanced practice nurse who can diagnose and treat mental or emotional disorders. In Massachusetts, they are authorized to prescribe medications. Delirium is a sudden onset of memory problems that also cause impaired attention and judgment. Dementia refers to a group of symptoms including memory loss, confusion, disorientation and judgment issues. Depression is a mood disorder characterized by intense feelings of sadness with symptoms including a change in sleeping patterns, loss of appetite, fatigue, and feelings of hopelessness that persist beyond a few weeks. DSM is an official manual of mental health problems developed by the American Psychiatric Association. Psychiatrists, psychologists, social workers, and other health and mental health care providers use this reference book to understand and diagnose mental health problems.
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58
Dual Diagnosis refers to a person who has both an alcohol or drug problem and an emotional/psychiatric problem. Durable Power of Attorney is the authority granted to a person to handle another person's financial affairs during periods of sudden incapacity or incompetence. ● A general power of attorney becomes effective when the document is executed and gives the agent immediate power to act if necessary. ● A springing power of attorney is drafted but "springs" into action only when the person becomes incapacitated. 59
48
Hallucinations are experiences or sensations that have no source including hearing nonexistent voices, seeing nonexistent things, and experiencing burning or pain sensations with no physical cause. Health Care Proxy is a document that allows a person (adult) to choose a health care agent who can make health care decisions for the person when he or she is unable to do so. Living Will is a document that provides instructions about a person's wishes to receive or refuse treatment if unable to communicate because of a terminal illness or condition. It is often done in the same way as a regular will with two witnesses and a notary public. The terms of a living will may be changed or revoked at any time if a person is mentally competent to do so. Mental Health refers to how a person thinks, feels and acts when faced with life's situations. This includes handling stress, relating to other people and making decisions. Mental Health Problems include depression, bipolar disorder, attention-deficit/hyperactivity disorder, anxiety disorders, eating disorders and schizophrenia. Obsessive Compulsive Disorder (OCD) is an anxiety disorder described as persistent thoughts that turn into repetitive behavior that interferes with daily activities. Panic Disorder is an anxiety disorder characterized by intermittent episodes of intense fear along with physical problems such as dizziness, shortness of breath and heart palpitations. Paranoia involves feelings of persecution and an exaggerated sense of self-importance. The disorder is present in many mental disorders and is rarely an isolated mental illness. A person with paranoia may work and function in everyday life since the delusions involve only one area.
ELIMINATING BARRIERS TO MENTAL HEALTH TREATMENT
Phobic Anxiety Disorder is an anxiety disorder characterized by a significant, persistent and unreasonable fear of an activity or item. Post-Traumatic Stress Disorder (PTSD) is an anxiety disorder that develops as a result of witnessing or experiencing a traumatic occurrence, especially a life-threatening event. PTSD can cause or interfere with a person's ability to hold a job or to develop intimate relationships. Psychiatrist is a professional who completed medical school and training in psychiatry and is a specialist in diagnosing and treating mental illness, including prescribing medication. 49
60
Psychologist is a professional with a doctoral degree in psychology who can diagnose and treat emotional or mental disorders and provide psychological testing. Schizophrenia is a mental disorder with symptoms that may include hearing internal voices, hallucinations, disordered thinking, social withdrawal, extreme apathy, diminished motivation and blunted emotional expression. Seasonal Affective Disorder (SAD) is a form of depression that appears to be related to fluctuations in the exposure to natural light. It usually strikes during the fall and often continues through the winter when natural light is reduced. Symptoms of SAD can be relieved by using a "light box" which produces light from a special full-spectrum light source. Social Worker is a licensed professional who provides service to individuals or families and assists with day-to-day problems. Advanced level Social Workers (LCSW, LICSW) may diagnose and treat emotional or mental disorders. Substance Abuse is the misuse of prescription or over-the-counter medications, alcohol or illegal substances.
A GUIDE FOR MASSACHUSETTS ELDERS, FAMILIES AND CAREGIVERS
Appendix F: Common Abbreviations
61
AA AAA ADD ADL ADM AMA AMB/amb ASAP BPD CA CD CHHA CLT CM COA CMHC DMH DMR DPH DR/Dr EA EEG ER EOHHS ETOH HX IEA ISP ITP LCSW LICSW PC PCP PERS POA
Alcoholics Anonymous Area Agency on Aging Attention Deficit Disorder Activities of Daily Living Admitted/admission Against Medical Advice Ambulation Aging Services Access Point Borderline Personality Disorder Consumer Advocate Conditional Discharge Certified Home Health Agency Client Case Manager Council on Aging Community Mental Health Center Department of Mental Health Department of Mental Retardation Department of Public Health Doctor Executive Office of Elder Affairs Electroencephalogram Emergency Room Executive Office of Health and Human Services Alcohol History Involuntary Emergency Admission Individual Service Plan Individual Treatment Plan Licensed Certified Social Worker Licensed Independent Certified Social Worker Protective Custody Primary Care Physician Personal Emergency Response System Power of Attorney
ELIMINATING BARRIERS TO MENTAL HEALTH TREATMENT
50
PRN PS PSYCH PTSD SA SPMI SPU SX TX
As Needed Protective Services Psychiatric Post Traumatic Stress Disorder Substance Abuse Severe and Persistent Mental Illness Secure Psychiatric Unit Symptoms Treatment
51
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Appendix G: Mental Health Websites Guidelines for Choosing a Mental Health Websites
Here are some guidelines to help choose websites that may provide useful information: ● ●
63
● ● ● ●
The purpose of the website is clearly stated The information covered does not appear to be an advertisement disguised as health education The information seems to be unbiased All aspects of the subject are covered adequately External links are relevant and working The information seems accurate and recently updated
Websites with helpful information: www.samhsa.gov SAMHSA: Substance Abuse and Mental Health Services Administration is a federal agency with a mission to focus attention, program, and funding for people with or at risk for substance abuse or mental illness. The website provides data, program information and information on mental illness and substance abuse. It also includes a mental health services finder so you can plug in your zip code and find services in your location. www.namimass.org NAMI-MASS: National Alliance for the Mentally Ill of Massachusetts is a grassroots organization with a mission to improve the quality of life for individuals affected by mental illness. It lists resources for individuals and families to get support in Massachusetts. www.nimh.nih.gov NIMH: National Institute of Mental Health is a federal agency within the National Institutes of Health in the US Department of Health and Human Services. The website has detailed information about signs and symptoms of mental disorders. It also has information about research and grant opportunities. www.mhselfhelp.org National Mental Health Consumers' Self-Help Clearinghouse is a consumer-run national organization that helps connect individuals to self-help and advocacy resources.
ELIMINATING BARRIERS TO MENTAL HEALTH TREATMENT
52
The site explains how to start your own consumer-driven advocacy group and provides materials on how to run groups. www.helpguide.org Helpguide is a project of the Center for Health and Aging aimed at educating people about mental health and mental illness. It discusses topics such as lifelong wellness and elder care. The site includes links to learn more about specific mental illnesses.
53
www.mhaging.org Mental Health and Aging is an organization that assists the elder population in finding the right services. It is an educational website that focuses on empowering individuals with the ability to seek proper care and treatment for their mental illness. www.eldermentalhealth.org Greater Lowell Elder Mental Health Collaborative is a coalition of agencies in the Lowell area dedicated to improving and increasing access to mental health services for elders. The website provides a glossary of terms including mental health conditions, professional provider types and service settings. The website provides a legislative update, notices of meetings and conferences, and a list of local providers. There is also information about caregiving and positive aging. www.mentalhelp.net Mental Help Net is an educational website focused on promoting mental health wellness, education and advocacy. Some resources include an advice column, symptom information, medication information, helpful telephone numbers and how to find a therapist. The site also contains lists of community chat rooms dedicated to answering questions pertaining to mental health issues. www.adscenter.org Resource Center to Address Discrimination and Stigma is an organization supported by the federal government. The site includes useful information and resources aimed at reducing stigma and discrimination towards individuals with mental illness. It also includes resources and information for special populations such as older adults and different racial groups. A list of books is available relevant to older adults with mental illness. www.mass.gov/dmh DMH: Massachusetts Department of Mental Health is the lead state agency within the Executive Office of Health and Human Services concerning mental health services
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in the Commonwealth. The mission of DMH is to assure and provide access to services and supports to meet the mental health needs of individuals of all ages, enabling them to live, work and participate in their communities. The website includes information on statutes, regulations and policies and eligibility guidelines for accessing DMH services. www.maclearinghouse.com The Massachusetts Health Promotion Clearinghouse is a program of the Medical Foundation funded by the Department of Public Health that provides free health education materials including materials for providers and the public on elder substance abuse. 65
www.mamh.org MAMH: Massachusetts Association for Mental Health is a private non-profit citizen-based organization established for advocacy and education. The website includes information about mental health issues. www.mhin.bu.edu MHIN: Mental Health Information Network is produced by the Boston University Medical Library in collaboration with DMH. The website provides information on resources and training for consumers and staff of the Metro Boston Area. www.mhsacm.org MHSACM: Mental Health and Substance Abuse Corporations of Massachusetts is comprised of 100 organizations in Massachusetts that provide mental health and substance abuse services. www.nmha.org NMHA: The National Mental Health Association is a national non-profit organization established to improve the mental health of all citizens through advocacy, education and research. The website includes information on mental health disorders, facts and figures, and national legislative and policy updates. www.positiveaging.org PARC: The Positive Aging Resource Center was established to improve the quality of mental health care and services for older adults. Brigham and Women's Hospital and Harvard Medical School's Division on Aging are the lead institutions for this national organization, providing education and technical support to older adults, caregivers, pro fessionals and policy makers.
ELIMINATING BARRIERS TO MENTAL HEALTH TREATMENT
54
www.health.org A National Clearing House for Alcohol and Drug information sponsored by the US Department of Health and Human Services and SAMHSA. The website provides information on prevention and treatment, and detailed descriptions of publications and facts by drug type. www.niaaa.nih.gov The National Institute on Alcohol Abuse and Alcoholism conducts research on the prevention and treatment of alcoholism and alcohol related issues. 55
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NOTES
NOTES
