- Joyce, we just saw in that story the community health worker model, which is meant to be part of a system or to fill gaps within the system.

Before we talk about that, what causes there to be gaps in the mental healthcare system to begin with?

- So there are lots of issues and one of them is simply that there are not enough people trained in geriatric mental health to provide services that understand the impacts of aging on our overall wellbeing and the things that can impact us as we go through later life and so that resource is not there.

And I think the other thing is, and I'm so glad they pointed it out in the video, people understanding what a mental health problem might be, dementia and cognitive impairments are not mental illnesses and shouldn't be treated as such.

But I think part of what the issue is, providers who may be helping a person may not know how to help them access the resource that will be helpful to them and the isolation that they mentioned is clearly an issue for many older adults.

- Thank you for that.

Kelly for many older adults, they're relying on public insurance to support them.

And as we saw in the video, maybe some of the processes aren't necessarily very customer friendly, shall we say.

What are improvements to be made?

- That's a great question and you know, Joyce, I wanna agree with what Joyce said about people being trained.

A lot of folks, we actually have a really robust mental health system, a public system.

So if you happen to have Medicaid, if you happen to have Medicare, we actually have a wide array of services now we have workforce struggles, which I think we'll talk about in a bit.

But there are kind of two really big barriers though, one is really stigma.

So it is folks being okay talking about mental health issues, caregivers, family, community members, being able to recognize the signs of mental health in an older adult and then access to the system.

So even though your insurance might cover a service, it doesn't mean you know how to navigate the system or who to call or how to find treatment.

So a lot of people think I need a psychiatrist, which is scary.

You probably don't probably need a counselor, a social worker or even talk to your pastor at your church.

But that navigation and entry into the system is kind of confusing, so when you talk about improvements, I think we do have workforce shortages, certainly in rural areas.

As Joyce mentioned, we don't always have a lot of folks trained and who can specialize in mental health treatment for older adults.

But just the stigma of of engaging in care and then trying to figure out how to navigate the care system are kind of two places that we need to work on and improve and there are areas that we are trying to work on and improve.

One more thing I'll mention is that, you know besides just navigating your insurance, even if you do have a robust benefit, we have a new crisis line in North Carolina, which is 998.

It's like 911, but it's 988 for mental health crises.

Tons, thousands of people are calling every day, 5,000 plus people call every month one of the smallest groups that are calling our adults 55 and older.

So we're not getting the message out to them that exists and or they don't feel comfortable calling yet, so some resources that are available need to be better marketed and we need to make sure they're meeting the needs of older adults.

- So I hear you saying awareness is an issue, - Yeah.

- Whether it's awareness of coverage of your insurance or awareness of a service like 988, what role does screening play in helping older adults become more aware?

A, that they might have a problem.

- Mm-mm.

- And B, they might have a problem that the system can support?

- Mm-mm.

Yeah, fantastic question.

So one of the programs that we have, it has a little bit of an old fashioned name, there are Gas Teams, our geriatric and aging specialty teams.

Again, names a little old, right?

But we have Gas Teams in every community, they're made up of a clinical therapist, a nurse, and a mental health kind of technician.

Their sole job is free of charge to go into community places, it might be a senior center, it might be a primary care doc's office, it might be a faith-based organization to help people to understand the signs and symptoms of mental health, depression, anxiety, maybe even a substance problem in older adults, so the idea is to extend that mental health workforce into the community, right?

Help caring community members be able to recognize the signs and symptoms, so that is a really important program we have across the state free of charge where we're trying to train everybody to help and understand.

But we also have like a place that older adults often go and feel comfortable going is primary care, right?

- Mm-mm.

- Primary care.

So we're doing a lot, we have a lot of programs like a model called collaborative care.

So we do a lot to help train and work with primary care docs to screen in their office, 'cause a lot of people go to primary care, right?

Maybe not comfortable seeing a mental health counselor, but my primary care doc, so we're trying to make sure primary care docs feel equipped can screen and we're trying to pay for things like an embedded social worker in the practice, a psychiatrist you can call for consultation and those psychiatrists who are doing consultation are also offering trainings to those primary care docs.

So we're trying to to say like, "Okay, this is a place you might go, you might go to the senior center, you might go to your primary care doc's office."

How can we equip them with the tools to recognize mental health or substance use issues?

Help them screen maybe for signs and symptoms and then refer to a qualified mental health professional who could help them or if you have an embedded specialist in your primary care office, even better, that person doesn't even have to go anywhere else, they can go right there.

- Love it, so hopefully we'll have this in every primary care.

- Yeah.

- That would be great, office going forward.

Amber, let me turn to you for a moment.

The elderly population frequently encounters physical health challenges.

- Mm.

- I know this from personal experience, hearing vision loss and then of course there are the chronic conditions like arthritis or heart disease, how does the physical health of our seniors affect their mental wellbeing?

- Yeah, good question.

I think we need to look at, they both really go hand in hand.

Physical health can affect mental health and mental health undiagnosed can also affect the physical health as well, so I think that's important to recognize.

There may be signs or symptoms, whether it's somebody's chronic pain that they may have and we need to look at like the root cause of that.

It may not be just because that they are have a physical impairment, it may be strictly related to maybe there is persistent depression or anxiety that's emulating in some of the physical help.

- Mm-mm.

- And I think, you know some of the issues that we may have is a lot of older adults, they may just say, "Oh this is normal part of aging."

- Right.

- I'm having the aches and pains, but they're not really recognizing that it may be contributing to their mental health.

So they go to their physician.

- Mm-mm.

And their physician is really may possibly just looking at the physical aspect and not in turn asking those questions of what life changes have happened, what about your emotional health?

Instead they may be just treating the symptom of that physical health, which then maybe in turn go to added medication they may not have needed that added medication.

So I think when we look at overall healthcare, mental health is part of healthcare and that's what we gotta start looking at.

- It's what makes this collaborative model so exciting.

- Mm-mm.

- Because you know, everybody's trained in their little area, but if you're part of an entire group.

- Mm-mm.

- Then other people might see things that you don't see.

- Mm-mm.

- So very, very exciting.

Kelly, with the high number of us who are getting close to retirement age.

- Mm-mm.

- What does the state need to do to prepare?

We've talked about workforce issues.

- Mm-mm.

- How are we gonna prepare for this tsunami?

- Well I think I've mentioned that we are trying to be smart.

You mentioned kind of at the beginning of the program about really there's a mental health crisis and I appreciate that you have this NC Impact series.

We just need more mental health treatment altogether, so how we're trying to be smart is to think of ways that we can extend the workforce.

Like I mentioned, like how can we equip primary care docs?

How can we equip other folks in the community to be able to recognize and refer, how do we have larger state commodities like 988, which is a 24/7 crisis call line, so you always have someone to talk to if you need it.

Joyce mentioned again, making sure that the mental health folks that we do have in the community are well-trained in the unique needs of older adults.

Another interesting program that I'll mention, I love that community health worker segment, I'm a huge fan of community health workers.

We have something quite similar to community health worker and mental health and they're called Peer Support Specialists.

- Ah-huh.

- I dunno if you guys have a peer support specialist.

It's a person with lived experience, so it's a person who has had mental health issues or substance use issues, who is much more flexible than your traditional healthcare provider, you don't have to go to the office, they can come to you and they can share with you how they navigated the system.

They know what your bad days are like, so we have certified peer specialists and we have a relatively new program, it is our certified older adult peer specialists.

So this is really targeted to folks 55 and older, so the peer is actually an older adult who struggle with mental health or substance use issues.

So we're training three cohorts, we're trying to get 150 folks out there and it is a wonderful model.

People love talking to someone that knows what they've gone through.

- Of course.

- But also help them navigate the system because it can be really tricky.

But, so again, we're trying to think smart about workforce.

We do have an aging workforce or an aging group of adults, we need to make sure our current clinicians are trained.

We're extending as much as we can into to primary care and other places and senior centers and we're using people with lived experience.

I mean that to me is really, really exciting.

Folks who've really been there and can actually provide that level of care that you shared there with community health workers.

- Yeah well will they sleep on the floor of the hospital, that's the question.

- Peers are amazing, they are usually that person that takes your call at three in the morning.

- Yeah.

- Yeah.

- It's such a big question, the workforce challenges.

I wanna see Amber, Joyce, do you wanna add to the great answer that Kelly has given us?

- Absolutely, the issue of the workforce challenge and also going back to what Kelly said about the fear and the stigma related to seeking help.

And there are also resources where a family member, a caregiver or the older adult themselves can do a simple screening online to determine am I having some issues that are normal?

Because a lot of people, as Amber said, tend to think that depression, sadness, anxiety are a part of growing older and that's not part of the normal aging process and so people need to know that practicing good mental health is a healthy way to age.

- Mm-mm.

- And so I think that is so important that we learn to own our own health and make sure we're taking care of ourselves.

- That's really helpful, Amber.

- Yeah, and I also think like when people are choosing their profession, whether that's social work or in the mental health profession, it's critical that, you know the colleges are also helping guide people into the world of older adults, 'cause I think so much is youth-focused.

- Mm-mm.

- That we need to make sure that we are kind of letting people know of all different opportunities and allowing them to, you know work with older adults and understand that it's a whole new world and a profession really with older adult care.

- Mm-mm.

- Let me change just slightly Joyce, and I'm gonna direct this question to you.

Older adults see some of the highest rates of suicide of any segment of our population.

What are some conditions or risk factors of this age group that we should be aware of?

- Absolutely, so one of the things to point out too is that somewhere around 25 incidents of suicide happen for everyone that don't get reported.

So there are 25 older adults that have committed suicide that we don't even know about and that's because there are a lot of times when people are older, people assume that, "Oh, she just mistook her medication, she didn't intend to do that."

or "He, you know just a bad driver didn't intend to do that."

and so suicide happens even more than the data show.

- That's startling.

- Yes.

- That's the startling.

- Yes it's, and the other piece of it is that we can see a direct link between social isolation, loneliness, and elevated suicide risk.

- Mm-mm.

- And that connection to family, to community, to work.

Oftentimes in this country we see retirement as the golden age of retiring when we really ought be thinking about reinvesting, because disengaging might've been the theory of old in terms of how we should age, but really re-engaging in community and volunteer work is the way to keep oneself healthy.

And so I think that when people, because of many reasons, increased losses, you know when folks get to be in their nineties, they're looking around and they're wondering where their family and friends are.

And that's when they need to make sure that they're engaged so that they don't become victim of the loneliness, isolation and that elevated risk for suicide.

- Mm-mm.

- It's interesting because in the town hall that focused on youth, we talked a lot about the importance of connection, the same when we focused on veterans.

I mean, this is a cross-cutting issue and as our world changes, you would think we would be more connected, but it actually is the opposite, we people seem to be less connected.

- Mm-mm.

- Kelly, you are nodding so vigorously, during Joyce's answer.

I just have to ask you before we close this segment of the show, did you have something you wanted to add to that?

- I love everything that Joyce said and it was very powerful.

We were talking beforehand about the very high rates of suicide in the older population.

And we talk about it a lot in youth, 'cause it's horrifying, right?

No one to think suicide is the second leading cause of death among youth, but it's a tragedy at any age.

And we have incredibly high rates of suicide among older folks and I think, you know Joyce was talking about social isolation and I think there's a mystification of what mental health treatment even is, what depression even is, a sign of depression is isolating.

- Yes.

- A treatment, I was a therapist for many years.

A treatment for depression is getting out and socializing, it's not this mystical is all that.

It really is connecting to people, having a hobby, having a place to be.

It's actually one of the most effective treatments for depression.

But no, I just loved everything Joyce said about yeah, about that connection and how really important it is.

- Amber, a large part of the Pearls program works to reduce this issue of social isolation.

Let's talk some more about what is the importance of this and what kind of negative health impacts go along with social isolation?

- Yeah, addressing social isolation and solutions to improve it are critical.

They're critical for every age, but especially with older adults because there's so many life changes that occur later in life.

Social isolation, it's the studies and the evidence show that social isolation really can even be as damaging or more damaging as if somebody smoked 15 cigarettes a day.

- Stop, say that again.

- Social isolation as studies have shown, can be as damaging or more damaging as if the same as somebody smoking 15 cigarettes a day.

So it goes back to the physical side of it that we talked about earlier, but not only with social isolation, of course it's gonna lead to higher risk of depression, anxiety, weight loss even, cognitive decline.

There's so many implications of that working at a multipurpose senior center that we look at the holistic approach of individuals and when we looked at, you know what do we do?

What works?

How can we enhance it?

But more importantly, we recently focused on where are the gaps in services and one of the large gaps in services were providing direct mental health support.

And so while we had a team of social workers and we went to, you know home bound individuals 'cause we do home delivered meals or individuals would come to the senior center, we kept seeing over and over again that people needed more, not only did they need the social connections, so we increased, you know opportunities whether it was for in-person activities, but also virtual opportunities for individuals who are home bound to be able to make those social connections as well as being able to provide direct mental health support when that was needed.

- And I appreciate you saying that because obviously the social connectedness may be important but not sufficient for dealing with whatever the underlying issue is.

- Mm-mm.

- Because Kelly seems as though social isolation may go along with geographic isolation.

- Mm-mm.

- And that rural communities where people live far distances apart and transportation may be a challenge, may be particularly difficult for the elderly.

- Mm-mm.

- Can you talk to us a little bit about that and what are the opportunities for addressing those unique challenges?

- Yeah, absolutely.

So just in general, we know people in rural health just have less access or in rural areas have less access to healthcare.

So they're less insured and it is actually just much harder to get basic healthcare, let alone specialty healthcare and mental health has been considered specialty care for a long time, although I think it's basic healthcare, so it can be really hard to have insurance and then to have a really robust array of mental health services in rural areas.

And then we talked about the social isolation component, I think it's very different if you live in and you've got neighbors on either side of you who can say hello to you in the morning when you're getting your paper, or if they don't see you for a day, maybe knock on there door.

- Kelly do people go get their paper in the morning anymore.

- I do, they not do that?

Okay, I do.

Okay, well maybe it's my, well, I don't know.

I saw my milk, it's.

- This morning, but maybe I'm old school.

But I do think about, I get my mail every day and I see Mr. Ray across the street every day and I see Mr. Ray when he walks across the block.

And if I don't see Mr. Ray for a couple days, I wonder what happened to Mr. Ray, I do, that's just part of my life.

So I think if your neighbor is a mile down the road, I mean you just don't have that kind of natural support around you and I think there are opportunities though, right?

I'll mention the technical one first and then maybe the less technical one, but I do think we learned during the public health emergency that things like telehealth are extraordinary.

So technology, this is probably not the panel to talk about challenges with technology, but there a lot of good can come of technology and we found a lot of people during the public health emergency really embracing technology for mental health care, it really helped with stigma issues for a lot of people, so they felt comfortable logging on and talking to someone.

We just saw massive amounts of telehealth utilization for mental health care during the public health emergency and people are still asking for it.

So I think that's a real opportunity for people in rural areas who don't have maybe have access to accounts the right away.

I do think rural areas do present an opportunity for us to be smarter about mental health care.

Meaning I think about my own grandma, right?

Love my grandma so much part of her connectedness to her community and we grew up in a very rural area, her connectedness was her church, her faith.

- Mm-mm.

- And so her faith was helpful too, but like that notion of pastoral counseling and having those kind of community partnerships.

And I think there's so many local community opportunities for us to think about how mental health healthcare can work better with local community partners in rural areas and I think the faith community is like a really, really a good opportunity for us to do that better in rural areas.

So I think really, you know things like technology I think are great, but also just expanding our reach doesn't have to be within the traditional walls.

We can use community health workers, we can use faith partners or other social agency partnerships to just to be able to reach more people.

- So Amber, this is a community problem and as Kelly has said, it's gonna take lots of partners working together.

- Mm-mm.

- Tell us about some of the community partners you work with, how have you engaged them?

What is their role?

What does the constellation look like?

- Yep, being part of a community senior resource center, partnerships are critical.

There's not one agency that can do it all, you have to have those stakeholders, those partners to work together to collaborate as our approach in New Hanover County, we were very fortunate that the county commissioners gave us the, I guess the charge to build a master aging plan.

And through that master aging plan, we actually started right before the pandemic, but we were able to learn more about our community, what were the needs for older adult services.

But we were also able to engage those partnerships and those stakeholders not only for other agencies for us to identify what are the gaps and services, but from older adults themselves.

And then once the strategic plan was developed, it was adopted, then it was, okay, what are you gonna do with the plan?

And from that we were able to kind of expand on those partnerships and our reach and some of those partnerships might be even through our local communications departments, spreading the word, making sure that we're educating the community on the resources, home healthcare agencies, adult daycare centers, DSS, public health, local physician's office, faith-based communities, anyone who works with people.

- Mm-mm.

- To make sure they understand, they know about the resources in the community that can directly then help an individual, whether that's through connecting them through mental health services or connecting them to resources of how someone can make social connections that then in turns, reduces isolation, which then in turn improves their physical health, their sense of purpose.

We work with volunteer organizations, which is critical once somebody retires, okay, what's the next step?

What's the next stage in life?

You know, somebody might have worked their whole career and they had a day to day and retirement's exciting, but once you retire, okay, what am I gonna do on myself?

- Yeah.

- And so even working with those volunteer organizations to help people identify, okay, these are their skill sets, their knowledge base, where are the needs in the community that we can plug them in so they can give back to their community and even have that sense of purpose.

- And what amazing assets that is for a community.

I'm gonna turn to the audience for questions, we'll put a mic in the middle of the two rows and you can come up and ask her questions.

But I've got one final question for you, Joyce.

We're talking about everybody having a role to play.

- Mm-mm.

- What loved ones family members do?

How do they contribute to the solution given how complex this problem is?

- Yes, thank you.

And one of the things I think we have to remember first and foremost that families are families.

And some are that beautiful family that you see on television or you know, from Walton's Mountain, but not all families are connected in that way.

And so where families are connected, they are the first line of defense and they're that support and they're that love and they're that resource and they are to stay connected.

But when families are not there, one of the things that they can do is pay attention to those signs and symptoms and try to direct that loved one.

Maybe it's to their pastor, maybe you ought to talk to your doctor about this.

And really not being afraid to address the issue, so many families don't like to talk about the real stuff in the middle of the room.

And sometimes you have to do that and saying that, you know it seems like this is going on with you, why don't we get you an appointment with your doctor to try to start the conversation?

And I think that that gives a relief to the person who's needing the help that somebody does recognize.

And maybe they're not the one to fix it, but maybe they're the one who can get them to the place that they need.

- Yeah.

- And so when people are isolating, disengaging, not interested in the same things that they used to be.

- Mm-mm.

- Then that really is telling you something is going on that you need to pay attention to.

- Mm-mm.

- And I wanna say one more thing.

- Absolutely.

- About Kelly was said, we'd avoid the technology conversation, but I don't want to avoid it.

- Woo, go for it.

- Yes.

There's a lot of thought that a lot of older people, because they didn't grow up with technology, - Mm-mm.

- Don't like technology.

We have discovered through research and work that there are a lot of older people out there when given the right instruction can and will use technology.

And we recently received a grant to make technology and technology trainers like perhaps college students available to help an older adult learn to use a tablet, so that Telebehavioral health is an access point.

So while it's not for everybody.

- Mm-mm.

- It is a resource that older adults and their families can certainly use to access behavioral healthcare.

- Mm-mm.

- And I'm supposed to be asking the questions, not answering them.

- Yeah.

- But even with respect to social isolation, being able to get on FaceTime.

- Yes.

- And see your grandchildren.

- Yes.

- Is better than not seeing them, it's not the same.

- Yes.

- As them coming to visit you.

- Yes.

- But it does offer some reprieve from the loneliness.

Absolutely, yeah.

All right, ready for hard questions?

I just warmed them up for you now they're ready to go.

- I have a question for Kelly.

So the Gas Teams, if someone is interested in working with them, who do they contact to get information about them?

Is the team gonna work only with the agency or organization people or do they work individually with the clients that they need services?

And if they do, is there cost to the individual for any services they might receive?

- Great question.

- Great questions and I'm sitting here thinking what is our 1800 number?

But actually if you go to our website, division of Mental Health, Developmental Disabilities and Substance Use Services, you'll see information on the Gas Teams and how you can contact them.

And typically what they do is they go in and they train entities, everything from like the signs of mental health or substance use, how to do screenings, how to provide brief intervention.

They don't typically meet one-on-one and provide treatment.

There was no cost for what they do, they're just trying to build capacity and equip organizations to recognize mental health substance use and to refer.

So they also help those community agencies to understand like how you get a referral, like what is the number in your community that you call so you can actually get some services for an individual, but they typically don't provide directly to a person, but it is free of charge.

- This question's for anyone who wants to answer.

What, if any role do you think ageism plays in the prevalence of social isolation, loneliness, and elevated suicide risk among older adults?

And if you do believe it plays a role, what are your thoughts on addressing it?

- Great question.

- Yeah, we own that one.

We at the division of aging and adult services are working very hard to do what we call reframe aging.

As Governor Cooper said, back when we had a gathering to begin some work that we're doing, you know 40 is is 60 is the new 40.

And it's true, we have to rethink.

- Mm-mm.

- What our ages are and we have to learn to be our age, you had to learn to be five to tie your shoes and learn to be 15, to go on a date or 16 and you have to learn to be 60.

And so if we, and I'm speaking of all ages, don't consider that as we begin to face that next stage, then ageism can set in as a real, very, very invasive kind of problem that older adults do to themselves even, because it's been so practiced over the years that when you're old you know, you shuffle around or you do this or you get dementia.

No, that's not normal aging.

- Mm-mm.

- And so we are working very hard to get people to rethink how they say things, it's the words you use that matter.

Like, rather than saying senior citizen, maybe older person, mature adult.

And every time I hear somebody say, "I've had a senior moment."

no, you just forgot something.

And trying to turn that into a more positive image of what aging is because let's face it, it's part of our life cycle.

- Mm-mm.

- And there are many, many opportunities that come with growing older.

- Mm-mm.

- One of them is many of us feel a lot freer to express our own opinions and some of those are really good and helpful opinions.

- I love it.

- So yeah, there's a lot to be done and there's a lot that we wanna work on to reverse that thinking and to bring generations together in this space.

- Yeah, other thoughts on solutions?

- Yeah, we're the same way from a community standpoint.

Couldn't agree more is that's our mission, is to reframe aging from a society standpoint, for people to know that it's aging There's so much value in older adults, there's a lot of wisdom, there's a lot of knowledge and skills and while they contributed to the economic part of society for many years, once somebody retires, there's so much life to live, life experiences that somebody had to share.

- Mm-mm.

- Now they're gonna tell you with no filters.

- Yes, that's right.

- Yeah, love it.

- Yes, the honesty.

- That's right.

- The honesty of it.

So, absolutely and when we look at it from a community standpoint, of course we want to make sure that we're offering many different opportunities for different types of aging.

- Yeah.

- From the spectrum and I think too, like we can't just categorize older adults as one category.

- Right.

- You know, when we look at older adults, we typically look at as 55 and older, that's many generations of older adults that we're serving, but also there's a problem with internal ageism.

- Mm-mm.

- You know, as we continue to age, we can say, oh, my aches and pains and you know, things like that are, I'm just getting older or I'm having a senior moment and we've got to even reframe our own thinking of what aging is and get excited about it.

Yeah there's gonna be challenges, there is challenges in every stage in life and how we face those challenges is how we're gonna overcome them and also have kind of that emotional intelligence.

- Yeah love it, great question.

Additional questions, I don't want to make you all feel pressured here, but the veterans town hall went on for 20 minutes after the cameras were turned off, so.

- I could ask another one.

- Sure.

- They know me, always ask questions.

- And then I'm just gonna start looking at friends in the audience and calling on them.

- So the stigma associated with mental health care.

- Yeah.

- Is very pronounced in older people, how do we address that and make progress?

- I think with older adults, the stigma's probably the biggest reason why older adults don't, you know address their own mental health concerns or emotional health concerns.

Because then themselves might feel, well this is just normal part of aging, you know went through many different life experiences and I got over it.

But they also is the fear of maybe going and to a mental health provider, they might have the fear of, well, if I go to this provider, then they may say that I'm not able to live by myself anymore.

And I think that's part of the fear or what are people gonna think?

Trying to hide that part of it.

So stigma is a significant part that we have to overcome that, again mental health and addressing your own mental health, it's part of your overall health.

- Mm-mm.

- And just like if you were to have diabetes, you would probably go to an endocrinologist or to another physician.

Your mental health is part of your health and it's okay to reach out if you know that you're having persistent sadness or anxiety.

- Mm-mm.

- You know, you're helping yourself, you're advocating for yourself.

- Mm-mm.

- And I think that doing the thing that we're doing right now is having the conversation that this happens to people.

And I think that being available to people who may be having issues as a trusted friend who they can just let a little bit out and it's like kind of feeding that kitten under the barn.

You give him a little bit and he'll come out a little bit this day and you just gotta let him go back and then feed him a little more.

And I remember I used to tell my son when he was struggling in his adolescent years, well, I tell you what, I'll close my eyes and you can tell me.

And so ways that make people feel like it's okay to say, and it doesn't have to be the first time to a mental health professional, but just somebody who caress.

And and I think that, and the more education we can provide, the better that it's not something to be ashamed of.

- And it that it's also, we repeated it over.

It's not a part of normal aging to be sad or have anxiety all the time that's just not normal part of aging.

- And I think that's a delicate conversation though, I agree, it's not a normal part of aging, 'cause I think and you mentioned this, Amber, a lot of that gets internalized.

We talked a lot about the behavioral aspects of mental health, like go socialized, that's very behavioral.

Well isolation brings a lot of cognitive challenges and a lot of times people are, they're isolating thinking, I'm by myself, my spouse has died, my children are far away, my life is over.

That's the real cognitive barrier of things like depression and I think that needs to be addressed.

The thing I'll say about mental health though and I'm honestly of two minds because we are on a mission in my division to just say mental health boldly and be okay with it.

But if I know this for a fact, if I asked y'all like who's had a mental health diagnosis in their lives or taken medication or seen a clinician, I know one in four or five of you have, I know very few of you would raise your hand and this is the society that we live in.

So I'm on a mission to be okay talking about mental health, right.

At the same time as a clinician, I understand you meet people where they are and if older adults are not comfortable saying mental health, that's okay too, it's okay.

My grandmother, I love my grandmother y'all, if you talk to me for five minutes, I will, she's an amazing person.

My grandmother had bad nerves, how many of you know older adults who have bad nerves?

I know what that means, but that's how she could talk about it.

- Mm-mm.

- She had bad days and her anxiety was very high sometimes and she said I had bad nerves and that was okay, that was her way to be able to express how she felt and that was great.

I didn't have to say, "Well grandma, actually that's depression and mental health, you need to be able."

no, it's cool.

She said she had bad nerves, so I think sometimes just meeting people where they are using language, they're comfortable with using a setting or even a person, maybe it's their neighbor, maybe it's their spouse, that they're comfortable, that's okay.

Like let's speak in the language that people need to talk about so we can, you know just help them heal.

But you know, stigma it's better in some ways.

Like younger folks, when I talk with them about mental health, they're much freer and more comfortable talking about it.

But the culture that our older folks even I grew up in around mental health is real treatment's, pretty young.

The kind of arcane treatment we used to have, the facilities we used to put people in, if you're 70, you don't forget that you live through it and so you learn to be quiet.

We couldn't even say PTSD, we said shell shock.

I mean think about the things that generally people live through.

So it's okay, like know the burden that they carry and know that whatever language they wanna use to talk about it, they say social isolation, you know what I hear depression.

But if we won't call it social isolation, 'cause that makes them able to talk about, let's talk about it that way, so while we're simultaneously just all getting more comfortable saying mental health.

- Yeah.

To Joyce's point, let's just keep talking whatever language we need to use, let's just all keep talking.

- So I think one barrier we haven't talked about yet to accessing mental health treatment is cost and so I think particularly for older adults who, you know I'm thinking about folks who fall in that line of too much to qualify for Medicaid and get some of those Medicaid funded services.

But the folks who a 20% co-insurance for a Medicare accepting provider, if you can find one, is a bit too much.

So either systemic solutions or short term resources to share.

- Yeah great question.

- Oh my gosh, what a fantastic thing and I can't help but seeing Senator Berg [indistinct] know there, I think.

But I think like, and I think we have a long way to go in healthcare parity.

I know there's federal parody laws and there's new ones introduced, but this notion that you should be able to access mental healthcare and have it be paid for in a reasonable way, we have a long way to go .

Now that isn't a solution for you, but I mean I'm blessed, right?

I have insurance, my copays for behavioral health are four times what they are if I would go to see my primary care doc, why is that?

And I go to see my primary care twice a year, right?

Mental health, that is not how it works.

You need a course of treatment, eight sessions, 16 sessions, $85 a copay, and I have insurance.

So yeah, like we have to like acknowledge that like mental health I think is a basic right, you need it.

We do need insurers to just be cool with that and recognize that mental health is health.

It's pretty cheap actually, we don't pay therapists a lot, let's be honest, we don't.

But then when a person has to pay $85 out of pocket or even full pay because of co-insurance and things like that, so I just kind of griped about the problems in our system.

But it is hard to find resources and I will say there is wonderful, the generosity of the general assembly is a wonderful thing, we do get state dollars to help defray the costs.

There's only so much, but we are able to have some insurances for underinsured and sometimes those go to people with insurance, because their insurance is not paying for basic mental health coverage or the copay is successively high, so there are wonderful things like state dollars, a lot of clinicians are just great people, they offer sliding scales.

Community centers will have, I know Amber has social workers at her clinic, so like a lot of communities do really wonderful things free of charge, churches have pastoral counseling free of charge, those things can be hard to find.

But yeah, we do need just better parity in healthcare, it should just be like primary care, 50 visits a year, no copay, $5 copay, it's worth the investment.

- Yeah, I thought that was a great question with access and that's probably also one of the reasons why maybe older adults aren't accessing mental health services, because they're already anxious about their financial barriers.

- That's right, that's right.

- I know in our community in particular, our community saw the investment in themselves from taxpayer dollars investing in having a mental health program in the senior resource center.

We first used our American Rescue Plan Act dollars to fund that and then we saw the outcomes of that.

We saw the need, we saw how many people utilize the service and so our county saw the investment and we are continuing that service to be able to sustain it.

And with that, we don't charge copays because we know that that's a financial barrier for individuals.

We don't ask income questions with that, because that's also difficult, we might have individuals, you know that are paying high rent cost, food cost, and their income may be pretty decent, what we think is decent.

But when you look at the inflation and the cost of things, we wanna make sure those the individuals that are being served or being served well with quality service, but that they don't have to worry about that financial burden.

- Mm-mm.

- We have time for one more question, who's up?

- I know I think each of you have spoke to the importance of sense of purpose and the transition to retirement and how critical that life transition is and as a gerontologist in the local area, I often see how heavily overlooked that is.

So I'm just wondering if you have any thoughts on any work that North Carolina is doing or just thoughts on how we can share with our current geriatric workforce, how critical this life transition is and maybe as a public health approach to prevent some of these other mental health challenges?

- Mm.

- One of the things that we have underway at the Department of Health and Human Services is an effort to put together what we call a multi-sector plan on aging.

And what that effort recognizes is both the challenges and the opportunities of an aging population.

I mean, let's face it, we are faced on this planet with more older people than we've ever seen before and we have to address that in a way that does address the opportunities along with the challenges and that multi-sector plan we'll engage in how do we make communities and opportunities available to older adults as they age and as I would prefer to call it, reinvest in life in different things.

And so with that plan, it's a 10 year plan and we are engaging all levels of state government, community stakeholders, older adults themselves to be part of that, to address areas that will really give that opportunity to both be a plan for action for state government in terms of what services are needed, but also a plan for communities to consider how do we make the term age-friendly, which is we've been designated as an age-friendly state from ARP to make those opportunities available and something that's normalized in the community and not just something the well off people get to do, but that people with limited means are able to participate in their community.

And there's no greater way to help yourself than to help somebody else and we see that among older adults as well.

So we hope that this plan will be an opportunity for North Carolina to really capitalize, we're the ninth growers, excuse me, eighth fastest growing population of older adults in the country and we need to take advantage of that.

- Mm-mm.

- And where you talked earlier about using volunteer organizations, are there other ways in New Hanover you are ensuring that as people age or reinvest in themselves, they're able to do that in a way that reflects a life of meaning and purpose?

- Yeah.

So yeah, definitely volunteerism.

We have some programs through AmeriCorps seniors, which is a federal program and that's significant, we have over 600 senior volunteers.

- Wow.

- That contribute back just in our community alone.

But I think, you know with that, we also look at learning opportunities, whether that's learning a foreign language, going back to school, there's so many opportunities of how folks can reinvest back in themselves and then can give back to the community, whether that's going back into the workforce, but in a different maybe type of work than that they did, but on their own will and that their own time as well.

So I think that's a big part of it, but also just enjoying themselves, enjoying life and knowing what the resources are before you retire.

And I think some of those connections, like I don't know if folks know about the North Carolina Senior Health Insurance Program.

We get a lot of individuals before they retire, they're might be getting on Medicare soon and so they're getting bombarded with information and even our trained ship counselors then start to talk to the individual of, "Oh, did you know about these other community resources that may be available?"

It's not just about Medicare, but how you can stay healthy in your community and avoid social isolation and improve those social connections.

- Thank you.

Kelly I'll let you have the last word on this one because I am moved by the thought of purpose and meaning being a public health imperative.

- Mm-mm.

- I agree, I need to think of something profound to say to add to what Joyce and Amber said.

But you know, that really resonates.

I mean, it resonates for me as a human, I reached a certain age a few years ago and I sleep like a baby, right?

I would wake up at five in the morning and I would start to have these existential worries about I'm getting older and what is my life gonna be?

And I'm gonna retire in a few years and it's real for all of us.

And talking to Joyce for me personally, an hour ago when she was talking about reframing aging, and this is an exciting new chapter in your life that was so empowering to me just as a human, so just as a human listening to you is empowering to me.

- Oh.

- And I think us being able to carry that message, I would love to help you carry that message or mental health field to help you carry that message because that's profound.

It is a new exciting chapter, so I just appreciated learning from y'all and picking up some new tools and there's some ways I think we can partner together to kind of take that message.

- Thank you to our audience, thank you so much for those terrific questions.

It took a little bit of work to get you up to the mic.

- Yeah.

- But once you got there you were awesome.

- Yeah.

- Kelly, Amber, Joyce, thank you for joining us this evening.

Thank you for the words of wisdom and the affirmation, the total love fest chemistry on this panel.

And of course, we wouldn't end the show without thanking those people who appeared in videos, who trusted us to tell their stories of local innovations.

And of course finally, to our audience, thank you for joining, for listening for engaging Anita Brown Graham, this is NC Impact.