ABSTRACT

Mental health practitioners often bemoan the fact that older adults utilize mental health services less than do younger adults. It has long been known, however, that older adults do not separate their mental health symptoms from their physical symptoms (Brody, Kleban, and Moles, 1983). Indeed, primary care physicians are routinely confided in by their older patients regarding patients' mental health symptoms. This phenomenon was termed the "inseparability of mental and physical health problems" by Patricia Parmelee and her colleagues at a symposium during the 1996 Gerontological Society of America's annual meeting. Unfortunately for patients, physicians are not well trained in the assessment and treatment of psychosocial problems. Although physicians are required in the history and physical examination to document current social and psychological functioning of the patient, this is typically undertaken in a cursory manner. Physicians in both primary care and medical rehabilitation practices fail to detect routine problems such as depression in well over three-quarters of their cases (Lichtenberg et al., 1993; Rapp, Parisi, and Walsh, 1988; Schuckit et al., 1980). Patients, in tum, do not get the treatment they need. The lack of physician training, combined with the increasing evidence that psychosocial factors are very strong influences on health outcomes, provide great challenges and opportunities for mental health practitioners. The objective of this book is to help mental health practitioners meet these challenges and seize opportunities in health care. Three themes will be incorporated into each of the major ideas presented in this book: first, geriatric patients' needs are best served through multidisciplinary practice; second, given the changing

health care environment in the United States, empirical support must be provided for all new mental health practices; and third, this book will focus on a unique population-urban elderly from a midwestern city.