American Counseling Association member Laura Shannonhouse added a professional counselor’s voice to two recent events organized by the White House.

Shannonhouse, an assistant professor in the Counseling and Psychological Services department at Georgia State University, is part of a cohort of researchers working on a grant-funded project on suicide and aging adults. A recent conference call brought this issue to the attention of some of the highest leaders in the country. In April, Shannonhouse participated in a call on COVID-19 pandemic’s effect on mental health that included U.S. President Donald Trump, Vice President Mike Pence and other senior administration officials as well as leaders from the Substance Abuse and Mental Health Services Administration (SAMHSA).

Earlier, Shannonhouse also traveled to Washington D.C. to participate in the White House Summit on Transforming Mental Health Treatment to Combat Homelessness, Violence, and Substance Abuse, held in December 2019.

In addition to Shannonhouse, the grant team includes ACA members Mary Chase Mize, Matthew Fullen and Casey Barrio-Minton. Funded by the U.S. Department of Health and Human Services’ Administration for Community Living (ACL), the project focuses on training home-delivered meals workers in suicide intervention and mental health basics.

According to the Centers for Disease Control and Prevention (CDC), suicide is the 10th-leading cause of death in the United States. For many age groups, however, it ranks much higher, including as the eighth-leading cause of death among those ages 55-64.

Q+A: CT Online sent Shannonhouse, Mize, Fullen and Barrio-Minton some questions via email, to learn more about the White House events, their grant work and related issues.

What do you hope comes out of the White House task force meeting and conference call?

These meetings were convened with the purpose of creating awareness about key mental health issues, sharing information about innovative practices and connecting with national leaders who are charged with addressing many of these issues from a federal perspective. In light of these meetings, we hope that federal programs and policies will prioritize the mental health of Americans of all ages. By attending on behalf of our federal grant, we hope to raise awareness about suicide risk among older adults, as well as the Medicare mental health coverage gap that interferes with many of these people from accessing care.

From your perspective, what do our government leaders need to know. What are the needs right now?

There are many pressing issues that affect the mental health of Americans. One such issue is the lack of access to licensed professional counselors (LPCs) for Medicare recipients. Regulations governing which mental health providers are reimbursed through Medicare were last updated in 1989. Since that time, the mental health marketplace has changed dramatically. Current Medicare policy is not aligned with the realities of mental health practice in 2020.

For example, when we reviewed the Psychology Today provider database, a popular tool for locating mental health providers, only 12.49% of providers in this database accepted Medicare. This means that 60 million Medicare recipients are left without access to a significant number of eligible providers, including LPCs.

How has your grant work on suicide prevention for older adults changed with the COVID-19 pandemic?

We have several partnerships with local agencies dedicated to meeting the needs of older adults. Due to the pandemic, many of these agencies are having to reconfigure entire programs to ensure that physical distancing measures are enacted. This means that many programs that previously met in person have to shift rapidly.

Even the best efforts to do this have, unfortunately, resulted in greater social isolation and loneliness among older adults. Our team is hoping to collect data on how the pandemic is impacting vulnerable older adults who rely on home-delivered meals programs. We want to illuminate how to best address socialization needs while nutrition needs are also met.

Looking ahead, what do you see as long-term needs in this realm, as the pandemic continues?

As the pandemic continues we anticipate that social isolation and loneliness will become increasingly greater issues, especially for older adults. In a recent study by the John A. Hartford Foundation and the SCAN Foundation, 83% of adults ages 70 and older stated that they were prepared to self-isolate for several months. Notably, after only one month of self-isolation, 33% reported increased feelings of loneliness since the pandemic became widespread. Therefore, efforts to connect with this population and ensure that their mental health needs are addressed is vitally important.

Tell us more about the connection between your work and the need for Medicare reimbursement for LPCs.

Our work focuses on identifying and assisting older adults who may be experiencing psychological distress or suicide risk. A major question, then, is what happens after they are identified and referred for counseling and other mental health services? The vast majority of these older adults use Medicare to access the health care system, including mental health, and as the counseling profession knows all too well, counselors are not currently eligible to be reimbursed through the Medicare program, something we have been calling the Medicare mental health coverage gap (MMHCG).

Although this is an issue that the majority of practicing counselors have experienced firsthand, most aging and health care advocates are not aware that it is a problem. They are generally aware of the behavioral health needs of older adults, but not aware that the exclusion of LPCs makes it more difficult to address these needs.

What are some challenges and bright spots that you would want counselors to know about the Medicare issue?

There has been a great deal of progress made in regard to Medicare advocacy for counselors. When lawmakers, federal agency leaders and the public hear about the outdated Medicare mental health provider policy, they are largely sympathetic and want to determine how they can help.

For example, there are two congressional bills that focus on adding LPCs to Medicare. These are both bipartisan bills with a high degree of support. House Bill 945 has 116 co-sponsors and Senate Bill 286 has 31 co-sponsors, and both of these numbers represent forward movement (Find out more from the American Counseling Association Government Affairs team at counseling.org/government-affairs).

In January of this year, the Center for Medicare and Medicaid Services (CMS; part of the U.S. Department of Health and Human Services) determined that LPCs are viewed as Medicare-eligible when they provide services within opioid treatment programs. This represented a major victory.

Then, in early May of this year, CMS made a similar determination within rural health centers/federally qualified health centers, as long as counselors are working in a manner that is consistent with their scope of practice. ACA and other members of the Medicare Mental Health Workforce Coalition are now advocating that LPCs be included in any future COVID-19 stimulus bills that Congress considers. These are all exciting developments that reflect years of hard advocacy work.

What do you suggest counselors who are passionate about these issues do to get involved and/or advocate?

COVID-19 has outsized effects on older adults, which means that our collective response to what our “new normal” looks like must be done with their needs in mind. What makes this pandemic particularly insidious is the way that physical distancing elevates health risks associated with social isolation and loneliness.

Local agencies that focus on aging are keenly aware of this, but may not have the infrastructure in place to fully address older adults’ mental health needs. Counselors should consider the many ways that their gifts can be invested in community efforts to keep older adults connected. At the local level, this might look like working alongside other colleagues to pool some pro bono hours that could be donated to your local area agency on aging so tele-counseling can be shared with at-risk older adults.

At the national level, it means responding to Medicare advocacy alerts so that policies can be modernized to address older adults’ mental health needs.

Whether you are a full-time counselor, student or counselor educator, making a difference also means combating ageism whenever it creeps up, whether it occurs in conversations with friends or family, on social media, or within healthcare or counseling professions. By asserting that older adults are every bit as deserving of mental health services as people of other ages, members of the counseling profession combat ageism, strengthen the case for Medicare reimbursement and improve the lives of socially isolated older adults. 

 

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Learn more:

• Matthew Fullen participated in ACA’s recent Government Affairs and Public Policy Town Hall, and spoke about the Medicare issue: youtube.com/watch?v=liXnCVlGomM

• Video of the Dec. 19 White House summit, to which Laura Shannonhouse was invited: c-span.org/video/?467561-1/white-house-mental-health-summit-part-1
• Article on aging issues by Matthew Fullen in the Counseling Today archives (2016): “Have you gone gray?”

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Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.