The latest census numbers project that more than a quarter of New Hampshire’s population will turn 60 or older by the year 2030, up almost 40 percent from 2012.
And in that same year, the number of older adults with mental health problems could meet or exceed the number of younger adults with mental health issues.
Among the most common mental health issues: depression and alcoholism.
This silent epidemic is creating an array of challenges for the health care workforce in New Hampshire.
Dick Lievens of Tilton sits at a coffee shop in Manchester.
At 59, he sports a scraggly white beard and wears a faded denim shirt.
It’s a look that’s laid back, but does nothing to describe his state of affairs three years ago:
Life was just chaos.
Lievens started drinking heavily in his 50s.
It didn’t take long before I was totally out of control. I couldn’t go to work anymore. A couple of car crashes. Looking back at it now – it’s like, how could you think that was normal.
Lievens is now in recovery. Like many of his generation, his narrative reflects a growing trend of substance and alcohol abuse.
According to the Institute of Medicine, at least 5.6 to eight million older Americans — or one out of five —have one or more mental health and substance use conditions.
For those struggling with addiction like Lievens, their downfall often begins with prescriptions.
I’ve always had anxiety problems. Over the years, you get used to the medications. And you have to keep boosting them up. And it’s not working. And you start drinking to try and squash the pain. And both alcohol and benzodiazepines – the combination of both is super-dangerous.
After hitting bottom, Lievens recovered at Webster Place, a private residence in Franklin.
When I walked in the door and one of the guys came out to greet me – he was a resident – he put his hand on my shoulder and said you’re doing the right thing; it’s going to get better from here. That meant the world. I wanted to be that guy.
Two and a half years later, Lievens is one of those guys. He’s a mentor running support groups.
Webster Place uses lay people like Lievens to help others on the road to recovery.
Adults in New Hampshire who need short-term residential centers like Webster Place but with trained clinicians find only a handful of options.
And only one facility in the state has a medical staff — outside of a hospital — to monitor withdrawal symptoms.
Cheryl Wilkie directs the Farnum Center in Manchester says the building’s newest wing features a medical detox center.
Wilkie emphasizes that alcoholism or drug addiction is not a rite of passage reserved for the young.
And she says the Center doesn’t treat its older patients any differently.
But Wilkie does say that, older adults who become alcoholic may have had other addictions in the past:
Whether it’s food or it’s cigarettes. Whether it’s thought addictions, where we think too much. Whether there was some other thing they were consistently doing until they found alcohol and that may have been the thing that soothed them.
But whatever the age, Wilkie says roadblocks prevent many from seeking help.
Money is always an issue to getting treatment.
Fees for medical detox run around three thousand dollars. And one month of residential care? Twelve thousand dollars.
Insurance may cover some of the costs. Medicare does cover some substance abuse treatments, but with limits.
And most of the time, the insurance companies say we’ll pay for outpatient, not residential.
The Farnum Center reserves 16 beds for low-income patients.
But those who qualify for the state subsidy can expect to wait six to eight weeks.
Jennifer Kinsey coordinates an state-run program for those over 60 who need brief counseling for alcohol and substance abuse.
The program is called the Referral Education Assistance and Prevention program, otherwise known as REAP. Kinsey says:
There are very limited options for older adults if they have an alcohol problem. There aren’t easily accessible treatments or options for paying for treatment.
REAP gets funding from several state-run organizations: the Housing Finance Authority; the Bureau of Drug and Alcohol Services; the Bureau of Elderly and Adult Services; and the Bureau of Behavioral Health and New Hampshire’s Ten Community Mental Health Centers.
If we have somebody with an alcohol problem who is an older adult, we’re the most likely resource for them to address their drinking problem. And it can be effective.
Kinsey says the service is free, and isn’t isolated in a facility that counsels addicts. Instead, clinicians visit seniors at their homes, or sometimes at a senior center.
She says the program is designed to make them feel more at ease.
Older adults come from a period of time when there’s more stigma involved. And they have issues with transportation. And even if they were to go to a treatment program, they probably would feel less comfortable around people a lot younger than them.
REAP has been around for more than 20 years and is now expanding. The program is currently training 40 mental health counselors across the state in new methods of addiction counseling.
But as New Hampshire’s population ages, Kinsey says the state will need even more resources to address not only addiction, but mental health symptoms — like depression and anxiety — that put elders at risk for alcohol and drug abuse in the first place.
And geriatric psychiatrist Stephen Bartels agrees. He directs the Dartmouth Center for Health and Aging. He says:
So if we don’t train our entire health workforce around how to assess older adults on a myriad of problems, not just substance abuse, we’re in big trouble in the state of New Hampshire.
And as more seniors like Dick Lievens share their battles with alcoholism, the voices behind the challenge may become harder for the state to ignore.