There was a time when mental health was something avoided talking about in public. But times have changed.

The COVID pandemic left us traumatized, intensifying our feelings of social isolation, anxiety and depression—everyone from school children to the elderly. Compounding COVID’s impact has been the corrosive effect of social media, the continual litany of school shootings, not to mention the deep cultural divisions and political violence fraying our communities.

At any social gathering I attend these days, the mention of mental health struggles among one’s family is no longer an anomaly. More often than not, I’ve found that it precipitates an emotional conversation of shared stories and challenges, a search for elusive answers, treatments and solutions.

 The numbers tell a stark story. According to the National Alliance on Mental Illness:

1 in 5 adults in the U.S. experience mental illness each year, and 1 in 20 experience a serious mental illness.

1 in 6 youths aged 6-17 experience a mental health disorder each year, with half of all life-time mental illnesses beginning by age 14.

The United States is in the midst of a national mental health crisis that is both urgent and expanding. Yet, mental health continues to be framed as a niche concern. While the plight of young people affected by social media overuse draws much attention, the mental health needs of older adults remain largely under-addressed. Indeed, mental health touches every corner of society across the age spectrum.

Every year, the World Health Organization designates October 10^th as World Mental Health Day.  It’s an international day for mental health education, awareness and advocacy against social stigma—and a reminder of the need to invest in good mental health. (https://www.who.int/campaigns/world-mental-health-day). As we live longer than ever, the intersection of aging and mental health presents a profound challenge--and an equally profound opportunity. It’s a good time to pause for a few moments and consider how we can make mental health a core component of healthy aging—not just an afterthought.

          Overlooked Mental Health Needs of Older Adults

 According to the federal Centers for Disease Control and Prevention, fewer than half of older adults who experience some type of mental health concern receive treatment. Depression and anxiety are the most common issues, but these conditions are frequently dismissed as a “normal” part of aging. They are not. Left untreated, they increase the risk of physical illness, disability, and premature death.

Social isolation compounds the problem. The U.S. Surgeon General has declared loneliness a public health epidemic, with adults disproportionately affected. Loss of a spouse, declining mobility, and shrinking social networks can lead to isolation, which in turn drives depression, cognitive decline, and even increased mortality.

While dementia is often the most recognized mental health challenge of aging, it is far from the only one. A singular focus on memory disorders obscures the broader spectrum of mental health needs. An older adult may not have Alzheimer’s disease, yet still struggle daily with mood disorders, trauma, or the lifelong effects of developmental disabilities.

A particularly complicated frontier is the aging of people with intellectual and developmental disabilities (IDD). Thanks to advances in healthcare and community support, individuals with conditions such as Down syndrome, autism spectrum disorder, or cerebral palsy are living longer lives than in previous generations. But longevity brings new challenges.

For example, adults with Down syndrome are at higher risk for developing Alzheimer’s disease at an earlier age. Adults with autism often face higher rates of anxiety and depression, compounded by social exclusion and difficulty accessing tailored healthcare. Many older adults with IDD also lack family caregivers, creating gaps in housing, services, and social connection.

                                         We Need a Comprehensive Approach

This overlap between aging, mental health, and IDD requires a rethinking of how systems are designed. Historically, aging and disability services have operated in silos. Older adults, especially those with complex needs, often find themselves shuttled between primary care doctors, mental health specialists, aging services, and long-term care providers—without anyone taking full responsibility for coordination. People fall through the cracks, perhaps receiving piecemeal support for physical health, but inadequate attention to mental health.

This is a crisis in plain sight. But so is the opportunity to redefine aging, not as a period of inevitable decline, but as a stage of life where mental health and wellbeing are possible, expected, and supported. A truly comprehensive approach to mental health must include older adults, as well as those with intellectual and developmental disabilities.  

How do we do this? Well, it does require some major shifts in thinking:

1. Mainstreaming Mental Health in Aging Policy
   Mental health must be recognized as central to healthy aging. Just as we prioritize fall prevention, chronic disease management, or nutrition, we need systematic efforts to promote mental wellbeing across the lifespan.
2. Integration of Health and Social Services
   Care models like the Program of All-Inclusive Care for the Elderly (PACE) have demonstrated that wraparound services integrating primary care, behavioral health, and social supports can improve outcomes while reducing costs. Scaling up such models could provide a blueprint for nationwide reform.
3. Expanding the Workforce
   Training more psychologists, social workers, and primary care providers in geriatric mental health should be a national priority. Equally important is training frontline workers—home health aides, case managers—to recognize signs of depression, anxiety, or cognitive decline.
4. Addressing Social Determinants of Health
   Economic insecurity, housing instability, and food insecurity all exacerbate mental health issues. Policies that strengthen the safety net for older adults—affordable housing, adequate income supports, accessible transportation—can be mental health interventions as much as social programs.
5. Community-Based Prevention
   Local organizations, including senior centers, libraries, faith communities, can serve as vital hubs for connection and prevention. Initiatives that foster intergenerational relationships, volunteerism, and lifelong learning combat loneliness and create purpose.

The Vision: A ‘Ecosystem’ of Care

There’s one more policy shift we need to instill in our mental health infrastructure—and it’s a big one. That is, the shift from one overburdened pipeline—Medicaid—to what we call a multi-tiered “ecosystem” that incorporates Medicare, state-based programs and community services.

Currently, the default solution for those needing sustained mental health or daily support is Medicaid enrollment. While Medicaid is vital, it has many limitations. Eligibility rules are complex and exclude many middle-income families. Institutional bias often channels people into nursing homes or specialized facilities. This “Medicaid-or-nothing” model isolates people, drains families, and underutilizes community resources. We need a layered ecosystem that keeps people at home, supports their mental health, and integrates aging and disability care.

Here are some alternative or supplemental approaches that could keep people at home longer, reduce costs, and integrate mental health as a normal part of aging services:

• Expanding Medicare Mental Health & Home-Based Services. As of 2024, Medicare now covers more behavioral health providers, such as marriage/family therapists and mental health counselors. Medicare Advantage plans already allow supplemental benefits for in-home services, caregiver supports, and telehealth—this could be a lever for scaling.
• Middle-Market Solutions. Many older adults don’t qualify for Medicaid and can’t afford private care. But there are emerging models of subscription-based mental health and social support services that could be expanded via employer retiree benefits or bundled into Medicare Advantage.  Examples: Papa (www.papa.com) for companionship and Mon Ami (www.monami.io/ ) for check-ins.
  
  
• State-Based Home Care Programs. Several states have created non-Medicaid state-funded programs for home-based supports, such as New York’s Expanded In-Home Services for the Elderly Program, (EISEP). These programs provide case management, homemaker and respite services, without requiring Medicaid eligibility. Scaling such models nationally could reduce Medicaid dependency.
• Community-Based Prevention Models. Leveraging the services of Area Agencies on Aging (AAAs) can increase the delivery of low-cost wellness, counseling, and peer support. Also, volunteer-based check-in networks such as the Village to Village Network (www.vtvnetwork.org/ ) can provide emotional support and reduce isolation.

A Call to Action

The national spotlight on youth mental health also can offer important lessons for aging. Just as schools are being urged to integrate mental health into daily life, so too, should retirement communities, workplaces, and healthcare systems for older adults. Campaigns to reduce stigma, normalize conversations about mental health, and promote resilience should be intergenerational.  In fact, intergenerational programs that connect students with older adults can not only reduce loneliness for both groups, but help dismantle stereotypes about aging.

The challenges of mental health and aging are not insurmountable, but they demand urgency and vision. The solutions are not mysterious.  We know what works: integrated care, social connection, supportive housing, early detection, and investment in the workforce.

I realize that we’re in the midst of a chaotic and divisive political environment today, with lots of partisan debate over the cost and delivery of programs like Medicaid and Medicare. But this is precisely the time to do a deep-dive assessment of what we need to do going forward—striving for maximum effectiveness, while minimizing fraud, waste and abuse. A true national strategy for mental health must include older adults. If we act with foresight, we can transform longer lives from a period shadowed by untreated mental illness into one enriched by resilience, dignity, and purpose.

                                             —Ron Roel