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Invited Commentary
Health Care Reform
January 2015

Now Is the Time for True Reform of Mental Health Services

Author Affiliations
  • 1The Johns Hopkins University, Baltimore, Maryland
  • 2Department of Psychiatry and Behavioral Sciences, Johns Hopkins Bayview Medical Center, Baltimore, Maryland
JAMA Intern Med. 2015;175(1):65-66. doi:10.1001/jamainternmed.2014.6086

The rapid aging of the population is accompanied by commensurate growth in the number of individuals who have complex chronic medical conditions (diabetes mellitus, heart disease, lung disease, etc). These people are increasingly less able to interact with health care services outside of their homes. At the same time, those caring for older adults are increasingly stretched in their ability to deliver care. This is especially true in providing care for mental disorders associated with chronic disease. Older patients with complex chronic conditions have high rates of mental disorders, with depression and dementia being the most common. The latter impair quality of life, worsen medical outcomes, and place substantial burden on caregivers, as well as on care delivery.1 The interaction between age and mental disorders further complicates matters because rates of depression and dementia increase substantially with age, regardless of the presence of medical comorbidities. Their co-occurrence exponentially increases illness burden and the care necessary to meet that burden. Unfortunately, mental disorders in old age go substantially undetected and undertreated, especially in mostly homebound individuals.