Perceptions of Biopsychosocial Services Needs Among Older Adults with Severe Mental Illness: Met and Unmet Needs (Clinical Report‪)‬

The growth of the older population around the world is a well-documented phenomenon. An unprecedented growth of older adults with severe mental illness (SMI) is expected to accompany this changing demographic distribution. Close to 1 million older adults are thought to suffer from SMI now, and this number is expected to double by 2030 (Cohen, 2003). Close to 70 percent of these individuals reside in the community and rely on community mental health systems for treatment, support, and assistance (Rowland, Burns, Schafft, Randolph, & McAninch, 1997). Older adults with SMI must contend not only with the symptoms and consequences of their mental illness, but also with age-related changes in their physical health, functioning, and social resources. Despite the distinctive late-life issues of older adults with SMI and the anticipated demands this growth will place on community mental health systems, little research has been conducted to identify the unique needs of older adults with SMI (Auslander & Jeste, 2002). In the past, researchers limited their identification of client mental health needs to expert assessments made by mental health professionals (Brewin, Wing, Mangen, Brugha, & MacCarthy, 1987; Lynch & Kruzich, 1986; Mueser, Bellack, Wade, Sayers, & Rosenthal, 1992). In recent years, however, national and international policymakers and researchers have begun to recognize the importance of assessing need from the perspective of the individual with SMI (Arvidsson, 2001; Auslander & Jeste, 2002; McNulty, Duncan, Semple, Jackson, & Pelosi, 2003). Research indicates that mental health consumers' and providers' perceptions of need can vary substantially. Indeed, when comparing clients' and providers' assessments of need in 14 areas of living skills and clinical problems, Comtois and colleagues found no areas of significant agreement. Because a consumer's and a professional's assessment of need can differ significantly, it is important to note that the consumer's perception of need is crucial to his or her use of services. According to a study by Bengtsson-Tops and Hansson (1999), individuals with SMI are more likely to seek out informal and formal assistance for issues for which they recognize a need. The importance of mental health clients' perceptions of need for service is highlighted by Brekke and Long's (2000) findings that people with SMI who receive intense formal services have superior functional outcomes than do those who receive less intense services. Although some research concerning the needs and service usage of younger people with SMI has been conducted, very little is known about the particular service requirements of older adults with SMI. In response, the current study sought to identify the unique psychiatric, medical, and social services needs experienced by older adults with SMI and to examine factors influencing their experience of need.