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Laura Shannonhouse, member of the American Counseling Association, added a professional advisory voice to two events recently organized by the White House.
Shannonhouse, an assistant professor in the Department of Counseling and Psychological Services at Georgia State University, is part of a cohort of researchers working on a scholarship-funded project on suicide and aging adults. A recent conference call alerted some of the country's top executives to the problem. In April, Shannonhouse took part in a call for the impact of the COVID-19 pandemic on mental health, attended by US President Donald Trump, Vice President Mike Pence and other senior officials and officers from the Drug Abuse and Mental Health Authority (SAMHSA).
Previously, Shannonhouse also traveled to Washington DC to attend the White House Summit to transform mental health care to combat homelessness, violence, and drug abuse in December 2019.
In addition to Shannonhouse, the Grant team includes ACA members Mary Chase Mize, Matthew Fullen and Casey Barrio-Minton. Funded by the United States Department of Health and Human Services (Community for Community Living, ACL), the project focuses on educating domestic workers in suicide interventions and the basics of mental health.
According to the Centers for Disease Control and Prevention (CDC), suicide is the tenth leading cause of death in the United States. For many age groups, however, it is much higher, also as the eighth most common cause of death among 55- to 64-year-olds.
ACA member Laura Shannonhouse attended the White House Summit to transform mental health care to combat homelessness, violence and drug abuse in December 2019. Photo via Georgia State University.
Questions and Answers: CT Online emailed Shannonhouse, Mize, Fullen, and Barrio-Minton some questions to learn more about the events in the White House, their scholarship work, and related topics.
What are you hoping for from the White House Task Force meeting and conference call?
These meetings were convened to raise awareness of key mental health problems, to share information about innovative practices, and to contact national leaders who are tasked with addressing many of these problems from a federal perspective. Given these meetings, we hope that federal programs and policies will prioritize the mental health of Americans of all ages. By participating in our federal grant, we hope to raise awareness of the risk of suicide among older adults and the gap in Medicare mental health coverage that hinders many of these people from accessing care.
What do you think our heads of government need to know? What are the needs at the moment?
There are many pressing issues that affect the mental health of Americans. One such problem is the lack of access to licensed professional counselors (LPCs) for Medicare recipients. The regulations governing which mental health providers are reimbursed by Medicare were last updated in 1989. Since then, the mental health market has changed dramatically. The current Medicare policy does not correspond to the realities of mental health practice in 2020.
For example, when we reviewed the Psychology Today provider database, a popular tool for finding mental health providers, only 12.49% of providers in this database accepted Medicare. This means that 60 million Medicare recipients have no access to a significant number of eligible providers, including LPCs.
How has your scholarship work on suicide prevention for older adults changed with the COVID-19 pandemic?
We have several partnerships with local agencies dedicated to the needs of older adults. Because of the pandemic, many of these agencies have to reconfigure entire programs to ensure that physical detachment measures are taken. This means that many programs that were previously personally met have to be postponed quickly.
Unfortunately, even the best efforts to do this have resulted in greater social isolation and loneliness among older adults. Our team hopes to collect data on how the pandemic affects vulnerable older adults who rely on homemade meals. We want to shed light on how best to address socialization needs while meeting nutritional needs.
What do you see as long-term needs in this area in the future if the pandemic continues?
As the pandemic progresses, we assume that social isolation and loneliness will become increasingly serious problems, especially for older adults. In a recent study by the John A. Hartford Foundation and the SCAN Foundation, 83% of adults aged 70 and over said they were ready to isolate themselves for several months. Remarkably, after just one month of self-isolation, 33% reported an increased feeling of loneliness since the pandemic spread. Efforts to connect with this population and ensure that their mental health needs are addressed is essential.
Tell us more about the relationship between your work and the need for Medicare reimbursement for LPCs.
Our work focuses on identifying and supporting older adults who may be experiencing psychological stress or suicide risk. So an important question is what happens after they are identified and referred for counseling and other psychiatric services. The vast majority of these older adults use Medicare to gain access to the health system, including mental health. As the counseling profession knows all too well, counselors are currently not eligible for reimbursement through the Medicare program, which we have called Medicare Mental Health Gap (MMHCG).
Although this is a problem that the majority of practicing counselors have experienced firsthand, most advocates of aging and health care are unaware that it is a problem. They are generally aware of the health behavior needs of older adults, but are not aware that excluding LPCs makes it more difficult to meet those needs.
What challenges and bright spots should counselors know about the Medicare problem?
Great progress has been made with Medicare advocacy. When lawmakers, federal leaders, and the public learn about Medicare mental health providers' outdated policies, they are largely compassionate and want to find out how they can help.
For example, there are two Congress bills that focus on adding LPCs to Medicare. These are both cross-party bills with a high level of support. House Bill 945 has 116 co-sponsors and Senate Bill 286 has 31 co-sponsors. Both numbers represent forward movement (for more information, contact the American Counseling Association's Government Affairs team at Counseling.org/government-affairs).
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In January of this year, the Center for Medicare and Medicaid Services (CMS; part of the United States Department of Health and Human Services) determined that LPCs are considered Medicare-enabled when providing services under opioid treatment programs. It was a great victory.
At the beginning of May this year, CMS made a similar decision in rural health centers / state-qualified health centers, provided that the advisors work in a manner that corresponds to their area of activity. ACA and other members of the Medicare Mental Health Workforce Coalition are now advocating that LPCs be included in future COVID-19 stimulus programs that Congress is considering. These are all exciting developments that reflect years of hard legal work.
What do you suggest to consultants who are enthusiastic about these topics in order to get involved and / or stand up for them?
COVID-19 has an overwhelming impact on older adults, which means that our collective response to what our “new normal” looks like must be done taking their needs into account. What makes this pandemic particularly insidious is the way physical distancing increases the health risks associated with social isolation and loneliness.
Local agencies that focus on aging are well aware of this, but may not have the infrastructure to fully meet the mental health needs of older adults. Advisors should consider how their gifts can be invested in community efforts to keep older adults connected. At the local level, this could look like working with other colleagues to summarize a few pro bono hours that could be donated to your local aging agency so that the teleconsultation can be shared with vulnerable older adults.
At the national level, this means responding to Medicare alerts so that policies can be modernized to meet the mental health needs of older adults.
Regardless of whether you are a full-time counselor, student, or counselor educator, a difference also means fighting ageism as it creeps in, whether in conversations with friends or family, on social media, or in health or counseling jobs . By claiming that older adults deserve as much psychosocial benefits as people of other ages, counselors fight ageism, strengthen arguments in favor of Medicare reimbursement, and improve the lives of socially isolated older adults.
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Further information:
Matthew Fullen attended ACA's recent government and public order city hall and spoke about the Medicare issue: youtube.com/watch?v=liXnCVlGomM
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Follow Counseling Today on Twitter @ACA_CTonline and on Facebook at facebook.com/CounselingToday.
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It should not be assumed that opinions and statements in articles that appear on CT Online reflect the opinions of the publishers or guidelines of the American Counseling Association.
