Geriatric services: community mental health center boon or bane?

The fragmented and uncoordinated development of federal and state mental health policy for the aged, the lifting of federal mandates for CMHC service emphases on the aged, and the underutilization of CMHC services by the aged all raise the issue of the implications of CMHCs emphasis on services to elderly clients. We hypothesized that CMHCs with increases in aged clientele would fare worse in terms of budgets, services, and staffing than those that did not report increases in elderly clientele. The findings are more complex in that, compared to centers with no change in aged clientele, CMHCs fared better when they either had decreases in aged clientele (as expected) or increases in such clientele (in contradiction to the hypothesis), although the former relationship was stronger. These findings are interpreted in terms of the need for CMHCs to specialize either on the aged or on other client populations. Such specialization, and the stronger effect for de-emphasis on the aged, suggest greater barriers to access of the aged to community mental health care.