Trends in CMHC Services to Elderly Populations

In 1984 CMHCs were still adjusting to federal and state funding cuts for, and Medicaid restrictions on, mental health services. To cope with such reductions, the centers continued efforts to genenate revenues from private sources. Declining access for low-income clients did not yet seem to be a problem; the vast majority of CMHCs surveyed had a predorminantly low-income clientele.

Reflecting a continuing national trend, the CMHCs in our survey consistently reported increases in the number of clients seeking care. Almost two-thirds (62 percent) of the CMHCs had waiting lists, and nearly half reported increased numbers of aged clients. This may signal an emerging trend to address the chronic neuropsychiatnic problems of the elderly within the CMHC system.

The findings of our survey suggest that the emphasis on providing community care for the chronic mentally ill has not compromised geriatric services, contrary to reports in the literature. The focus on day treatment for the aged may mean greater state commitment to fund services for patients (including the aged) with chronic mental illness. An example is California's appropriation of $20 million in fiscal year 1986 for services to chronic mentally ill homeless adults and those at risk of becoming homeless.

It is not clear whether these trends will continue or what their impact will be on other health or social service providers. State CMHC funding may remain at current levels or even increase. However, it is likely that attempts to reduce the federal deficit will further decrease social spending. Federal revenue policies, such as any elimination of the federal income tax deduction for state and local taxes and the abolition of revenue sharing, could also have ripple effects on states. Funding priorities would have to be reoriented to adjust for such shifts, as they did after passage of the Omnibus Budget Reconciliation Act of 1981. Community mental health centers would then face a worsened fiscal situation that could significantly erode recent improvements.