TESTIMONY PRESENTED BY SPOP TO THE NEW YORK CITY DEPARTMENT OF HEALTH AND MENTAL HYGIENE, April 14, 2012

Good afternoon. I am Robert Tobing, Director of Program Operations at Service Program for Older People, Inc., or SPOP. SPOP is a community-based mental health agency that serves about 1,000 older adults each year. We were founded 40 years ago and were one of the first agencies in Manhattan to focus on the comprehensive mental health needs of older people.  

I am pleased to speak today about new ways that SPOP is working to meet the mental health service needs of New Yorkers.  

SPOP serves a population that is often difficult to reach and to treat. Mentally frail adults are often physically challenged, isolated, and unable to travel to appointments. Many of our clients do not speak English or are reluctant to seek mental health treatment for cultural reasons. I will speak about some of the ways that SPOP has broken down barriers to treatment for some of the most vulnerable members of our community, and how that treatment has helped to keep adults healthy, independent and active in the community, often averting costly hospitalizations. 

The geriatric population in New York City is expanding overall, and two of the fastest-growing segments of the population are those who are physically frail and those who are among racial or ethnic minority groups. When you consider that one in four older adults in the general population experiences mental illness or behavioral disorders, you can see that here in New York we are looking at a disproportionately large population of older adults in need of mental health treatment who are either physically frail or minority or both.  

Traditional delivery of services is built on the assumption that older adults will come into an office to obtain services.  Unfortunately, this model does not work for those who are too frail to leave their homes.  

SPOP was a pioneer in offering mental health treatment to homebound older adults. Today over half of our clinic clients receive treatment in the home. Our homebound clients are generally among the most isolated, impoverished and fragile adults that we serve, and the treatment we provide is often the first step toward re-engaging them with family and society –  and the most important step in keeping them out of the hospital. 

We have also pioneered an approach to mental health treatment that is culturally sensitive and offered in the native language of clients, primarily Spanish. According to DFTA, Manhattan, which is SPOP’s catchment area, has the largest elderly Hispanic population in the City. These older adults are particularly susceptible to social isolation – especially those who are unfamiliar with English – and they have limited access to mental health services that are culturally and linguistically appropriate. For those who are homebound, behavioral and physical health treatment compliance is especially challenging.

To meet this need, SPOP has reached out to Spanish-speaking adults over age 55, including those who are homebound. We have expanded our staff of bilingual social workers and psychiatrists, and we routinely venture into ethnic and linguistic enclaves in order to engage with non-English speaking clients.  Today 19% of SPOP’s homebound clientele is Spanish-speaking.

The cost of not treating mental illness in the elderly is high. Older adults with mental illness are less able to care for themselves or seek care, and untreated mental illness can directly contribute to the development of physical illness.  

The continued growth of the elderly population will expand the need for mental health services. We urgently request that the New York City Department of Health and Mental Hygiene continue to support mental health care for the elderly, particularly those who are homebound and those for whom English is not the native language.  

Thank you for providing SPOP with this opportunity to submit testimony.