CORTE GEOLÓGICO DE LOS MANTOS E.M CENZACONT SRL
MÉTODO DE EXPLOTACIÓN APLICADO AL PLAN DE MINADO
Fifteen to 25 percent of older adults in the United States suffer from significant symptoms of mental illness. Persons over 65 years of age represent approximately 12 percent of the total population of the United States, yet they account for over 20 percent of the suicides nationwide. Despite these statistics, fewer than four percent of individuals treated in mental health centers nationwide are over 65. And, less than 1.5 percent of the
My impression is that seniors who have mental health problems are not a priority, although people with severe mental illness who are
growing older are served. Many seniors who need mental health services are unlikely to visit traditional mental health facilities.
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direct costs for treating mental illness in this country are spent on behalf of elders living in the community.42 Reviewing the prevalence figures for older adults, the figures are actually lower for individuals over the age 65 who have SMI, however anecdotally we know that older adults do suffer from increased depression as loved ones pass, and other life changes create stress. We know from community members that older adults with mental illness have a harder time accessing services due to their mental illness. And there are multiple systemic barriers when a person with mental illness grows older and begins to experience dementia or other organic brain disorders as they may no longer qualify for mental health services. During FY 04, 5,254 individuals over the age of 65 were enrolled in services provided by the Division of MHDDAD, comprising less than 1% of the total population served.
The Division of Aging within the Department of Human Resources has the responsibility of providing services to individuals who are aging and offers a plethora of supports and services targeted to individuals across the state through many different programs. However, at the state level there are two programs that are geared specifically to older adults with mental health issues: SPRINTD and the partnership with the Fuqua Center at Emory:
SPRINTD – Specialty Providers in Teams for Dementia Care
Specialty Providers in Teams for Dementia Care is a grant with the Rollins School of Public Health at Emory University. SPRINTD addresses ways in which caregivers handle disruptive behaviors to people for whom they provide care. This helps delay people going into Nursing Homes because their caregiver could no longer deal with the stress of supporting someone. The program teaches caregivers new ways to provide support and intervention and so they don’t get burned out. The training also helps caregivers understand that this is not behavior focused on them but rather is the disease process resulting in the challenging behaviors.
Fuqua Center for Late-Life Depression – at Emory University in Atlanta
The Fuqua Center is focused on improving access for older adults to treatment for depression and improving public awareness and understanding of depression in older adults in order to de-stigmatize and eliminate discrimination associated with mental illness.43 The Division of Aging partners with the Fuqua Center to provide supports to older adults with late-life depression and to provide training for staff about late-life depression. Training has been provided to help care coordinators know how to talk with someone about depression and suicide, and what type of intervention may be provided. Additionally The Fuqua Center provides a variety of clinical services for the older adult. These include outpatient services, community clinics, group therapy, referral services, and telemedicine services.
42 These facts were extracted from a literature review conducted by the American Psychiatric Association, 1998
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D. Homeless Mentally Ill
In 1996, it was estimated nationally that 637,000 adults were homeless in a given week. In the same year, an estimated 2.1 million adults were homeless over the course of a year. However, discerning exactly how many people are homeless in Georgia and who are in need of and receive mental health services is extremely difficult. The transient nature of individuals who are homeless leads to inconsistent data collection across the multitude of agencies that provide support to this population.
- The Division of MHDDAD information system for FY05 reports that 1,799 public mental health service system enrollees were homeless, or listed a shelter as their primary residence. However, the majority of these fields are not populated, so 1,799 out of 26,647 of those entries that were populated equates to 6.7% of the population enrolled in services as Homeless.
- From PERMES reports, which are sample surveys that are completed by
consumers, the DMHDDAD reports regional percentages of homeless consumers from the samples that can then be applied to the greater numbers.
- The statewide information system tracking homeless individuals, titled
“Pathways” collects information on homeless individuals throughout the state, though the primary focus is on the metro Atlanta area
- Reports from providers of PATH services report that they served 733 homeless clients during FY03 (the most recent year statistics were available)
o However reports to the federal program administrators report that there were 1,623 homeless clients enrolled in services during FY03
All of these differing methodologies for determining the number of homeless mentally ill served by the public system is evidence that there currently exists no exact way to
calculate the total. Using one of the methodologies noted above, the PERMES surveys and sample results, APS predicted the number of homeless people served per region by applying the sample size percentage of homeless to the total number served as seen in Table VII-3.
TABLE VII-3: Estimation of Number of Homeless Individuals Served per Region
Central Region
East Central Region
Metro Region North Region Southeast Region Southwest Region West Central Region 1,228 789 3,427 1,156 1,004 712 1,189 Using this methodology the statewide percentage is 5.5% of all consumers are homeless,
with regional variance across the state.
The Federal PATH Program in Georgia
Georgia receives federal funds in the amount of $698,000 matched with $512,380 state funds for a total of $1.2 million to support the PATH program to serve persons who are homeless and have a mental illness throughout the state. Federal funding is based on a census formula. PATH funds are contracted through the DMHDDAD to provide
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services. During FY2003 1,726 received services, and a total of 830 enrolled in the PATH programs, agreeing to ongoing treatment. Georgia’s Path program primarily serves adults:
20% between 18-34 years 56% between 35-49 years 21% 50-64 years
2.6% over 65 years
Less than 3% of the clients served were over the age of 65 indicating that this population is even harder to reach than others. The majority of the clients fall between ages 35 – 49, however nearly one fourth are between 50 – 64 years. 70% of PATH clients are African American, making up a disproportionate amount of the population. 22% of PATH clients are white, while only 7% were of Latino background. However, serving 7% Latino clients, PATH serves a higher percentage than the total MHDDAD system (3%). PATH programs are operated by the following providers within Georgia:
Albany Advocacy Resource Center
Central Fulton Community Mental Health Center at Grady Health System Community Concerns, Inc
Community Friendship, Inc. Homeless Authority of Savannah Integrated Life Center, Inc MaySouth
New Horizons Community Service Board River Edge Behavioral Health Care St. Joseph's Mercy Care Services Peer to Peer outreach
MHP in homeless services
From the FY2005 Federal Budget - Funding for the PATH grants supporting mental health services for homeless people is expected to grow to $55 million, an increase of $5.5 million from FY 2004.
In addition to the PATH program operated by social service organizations throughout the state, there are other programs operated under the umbrella of the Department of
Community Affairs (DCA). DCA is the lead housing agency within the 149 counties and administers the Section 8 program as well as the Shelter Plus care program. Both
programs offer subsidized housing for people with low incomes. Shelter Plus care is specifically targeted to individuals with special needs such as mental illness or older adults who may be at risk for homelessness. The use of Shelter Plus Care housing subsidy to support individuals with mental illness is expanding with a partnership
between Must Ministries in Marietta and the Cobb/Douglas Community Services Board. Services are delivered to individuals within the community setting, in this case their own apartment.
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PATHWAYS
Congress has ordered the U.S. Department of Housing and Urban Development to make sure that each community across the country has implemented a system to:
• Provide an unduplicated count of people who are homeless
• Quantify use of homeless services
• Measure the effectiveness of their local homelessness assistance systems
In Georgia more than 160 homeless service organizations across the state are now linked through the state's Homeless Management Information System (HMIS) titled
PATHWAYS44. PATWAYS is designed to compile data on homeless clients, has the ability to generate an unduplicated count of homeless persons across jurisdictions,
calculates shelter turnover rates, develops client profile demographics, documents service use patterns, and details project and program outcomes over time. PATHWAYS also allows case managers to more effectively plan for the delivery of services, evaluate the appropriateness of the service based upon outcomes, and ultimately decrease duplication in service delivery. However, with the rapid increase of use of the system the training for its users has not maintained pace: critics site unqualified volunteers entering information into the system, making judgments on mental health assessments, and about substance abuse disorders. The users may not be skilled in assessment since many organizations are small volunteer shelters that don’t have the education or experience to assess clients for the presence of mental illness. Additionally, for some shelters that don’t receive state of federal funds, they have no mandate to use the PATHWAYS system, so consumers are not included in the statewide figures.
SAMHSA and the National Resource Center on Homelessness and Mental Illness offer suggestions for engaging the homeless mentally ill population in treatment and providing supports:
Most can be voluntarily engaged or re-engaged in treatment, housing, and support services. Mobile outreach can provide access to basic services, treatment, and housing.
Integrated mental health and substance abuse treatment delivered by multidisciplinary mobile treatment teams can reduce symptomology and improve functioning in the community.
Providing supportive services to people in housing has proven effective in achieving residential stability, improving mental health, and reducing the costs of homelessness to the community.5